HCV elimination unlikely to be hindered by suboptimal direct-acting antiviral efficacy
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The efficacy of direct-acting antivirals in people with HIV and hepatitis C virus originating from Sub-Saharan Africa and southeastern Asia but living in Europe is high, according to a recent study published in Open Forum Infectious Diseases.
The researchers added that this means hepatitis C elimination for this population in Europe is unlikely to be hampered by suboptimal direct-acting antiviral (DAA) efficacy.
“In high-income countries, hepatitis C virus (HCV) was mainly spread in the second half of the 20th century. Therefore, the genetic diversity of HCV in these countries is relatively limited,” Cas Isfordink, MD, PhD, researchers at the University of Amsterdam’s Amsterdam Institute for Infection and Immunity, told Healio. “In low- and middle-income countries, such as in Asia and Sub-Saharan Africa, HCV has most likely been around for multiple centuries and HCV strains are therefore genetically more diverse.”
Isfordink explained that the main registrational trials for DAAs were conducted in high-income countries and, therefore, only tested on a limited amount of HCV geno-/subtypes. Later, studies began reporting a reduced efficacy of DAAs for HCV geno-/subtypes that are common in certain low- and middle-income countries but uncommon in high-income countries.
“This could potentially hamper global HCV elimination efforts,” Isfordink said. “Since these respective studies included only very few individuals with HIV/HCV, we aimed to assess DAA efficacy among individuals with HIV/HCV from Sub-Saharan Africa or Asia living in Europe.”
Isfordink and colleagues retrospectively analyzed data from several prospective European cohorts of people living with HIV. According to the study, participants included individuals with HIV/HCV who originated from Sub-Saharan Africa or Southeast Asia and who were treated with interferon-free DAA, and had an available HCV RNA result 12 weeks or more after end of treatment. The primary outcome of the study was SVR-12 .
Overall, 3,293 individuals with HIV/HCV treated with DAA and with available SVR-12 data were included — 64 were from Sub-Saharan Africa and 78 from Southeast Asia. According to the study, SVR-12 was achieved by 60 (94%; 95% CI, 86%-98%) individuals from Sub-Saharan Africa and 76 (97%; 95% CI, 92%-99%) from Southeast Asia. The study revealed that the genotypes of the six individuals failing DAA treatment were 2, 3a, 3h, 4a, 4c, and 6j.
“DAA efficacy in individuals with HIV/HCV from [Southeast Asia or Sub-Saharan Africa] living in Europe is high,” Isfordink said. “Therefore, it seems unlikely that HCV elimination in this population will be hampered by suboptimal response to DAAs.”
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