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French patients with HIV/HCV achieve high SVR rate

Researchers observed a significantly high sustained virologic response among patients coinfected with HIV and hepatitis C who were enrolled in the French nationwide ANRS CO13 HEPAVIH observational cohort study, according to a recently published report.

“Hepatitis C (HCV) co-infection is frequent among people living with HIV, with a reported prevalence of 15% to 30% and up to 82% among injecting drug users,” Lionel Piroth, MD, PhD, from the Centre Hospitalier Universitaire de Dijon, France, and colleagues wrote. “In this real-life observational cohort with prospective data collection, new all-oral DAA regimens were well-tolerated and had excellent virological efficacy in HIV/HCV coinfected patients. Thus, neither antiretroviral therapy, nor advanced liver disease, appears to undermine the anti-HCV treatment response in HIV/HCV coinfected patients.”

The study comprised 312 patients with HIV/HCV coinfection. Mean patient age was 53 years (50-56 years), 240 were men, 194 had cirrhosis and 221 had failed previous HCV treatment. Those who failed previous HCV treatment had used interferon, pegylated interferon with ribavirin or triple-drug regimens including Incivek (Vertex, telaprevir) or Victrelis (Merck, boceprevir).

Patients received treatment with combination sofosbuvir/daclatasvir with ribavirin (n = 181), Sovaldi (Gilead, sofosbuvir) with ribavirin (n = 51), Harvoni (Merck, sofosbuvir/ledipasvir) with ribavirin (n = 66), Olysio (Janssen, sofosbuvir/simeprevir) with ribavirin (n = 19) or another combination (n = 6).

Overall, 302 patients achieved SVR at 12 weeks for a success rate of 93.5% (95% CI, 90.2-95.9). The SVR rate ranged from 86.3% (95% CI, 73.7-94.3) with Sovaldi to 95.5% (95% CI, 87.3-99.1) with Harvoni, though there was no significant difference in SVR according to which DAAs were used.

Of the 21 patients who failed to achieve SVR, 15 had a virological relapse, four experienced virological failure, one had detectable viral load at 12 weeks but no data at end-of-treatment, and one died during treatment. Most patients who failed to achieve SVR were men with a median age of 54 years and had HCV genotype 1.

Ninety-four patients had adverse effects. Eleven patients stopped treatment prematurely for intolerance (n = 2), lack of virological response (n = 1) or unknown reasons (n = 8).

“This study provides important information on HIV/HCV-coinfected patients who are often omitted from clinical trials,” the researchers concluded. “We observed a high overall SVR12 of 93.5% ... in real-life settings. Neither the HCV genotype nor cirrhotic status influenced the SVR12 rate. Nonetheless, as this was an observational cohort study, this high rate of SVR12 might be due to more intensive treatment of selected patients.” – by Talitha Bennett

Disclosure: Piroth reports no relevant financial disclosures. Please see the full study for the other researchers’ relevant financial disclosures.