Sofosbuvir-velpatasvir safe, effective for patients with HIV/HCV coinfection

Treatment with sofosbuvir and velpatasvir produced a safe, sustained virologic response in patients with HIV who were coinfected with hepatitis C virus, according to findings from a phase 3 study.

“As HIV–related morbidity and mortality has decreased, liver-related complications have become a leading cause of death in coinfected patients,” Mark Sulkowski, MD, medical director of the Viral Hepatitis Center at Johns Hopkins University and an Infectious Disease News Editorial Board member, and colleagues wrote.

Researchers wrote that direct-acting antiviral agents offered safe and effective treatment for patients coinfected with HIV and HCV, and that current guidelines recommend coinfected patients receive the same treatment as patients with HCV monoinfection.

“However, choosing an appropriate regimen can be complex…” Sulkowski and colleagues wrote. “There remains an unmet clinical need for a simple well-tolerated, ribavirin-free, oral regimen with limited potential for interaction with HIV ART agents that is highly effective against all HCV genotypes.”

The researchers conducted an open-label, single-arm study at 17 centers in the United States, with all patients receiving sofosbuvir-velpatasvir once daily for 12 weeks (n = 106). The main endpoint was sustained virologic response at the end of treatment. Sulkowski and colleagues assessed safety and efficacy in all patients who received at least one dose.

Most patients were men (n = 91; 86%), and slightly less than half (45%) were black. About one-fifth (18%; n = 19) had cirrhosis. Overall, 101 patients achieved a sustained virologic response at 12 weeks (95%; 95% CI, 89-99). Patients who achieved sustained virologic response included 74 of 78 patients with genotype 1 (95%; 95% CI, 87-99), all 11 patients with genotype 2 (100%; 95% CI, 72-100), 11 out of 12 with genotype 3 (92%; 95% CI, 62-100) and all five with genotype 4 (100%; 95% CI, 48-100), Sulkowski and colleagues wrote. All patients with cirrhosis experienced sustained virologic response, the researchers reported. One withdrew consent, two were lost to follow-up and two patients relapsed.

Two patients experienced serious adverse events, and two discontinued treatment because of adverse events, the researchers wrote. Overall, the most common adverse events were fatigue (25%), headache (13%), arthalgia (8%) and upper respiratory tract infection (8%).

“In conclusion, sofosbuvir-velpatasvir for 12 weeks provides a simple, safe and highly effective treatment for patients coinfected with HCV and HIV,” Sulkowski and colleagues wrote. “Its effectiveness in a broad range of patients across a wide range of ART regimens suggests that it could be used by the majority of patients with HIV/HCV coinfection including those with prior treatment experience, compensated cirrhosis and non-genotype 1 HCV infection.” – by Andy Polhamus

Disclosure: Sulkowski reports advisory roles with Abbvie, Cocrystal, Gilead, Janssen, Merck and Trek, as well as research grants from Abbvie, BMS, Gilead, Janssen and Merck.