Chronic hepatitis C treatment in HIV co‐infection in Portugal: Results from a cohort OF 2133 patients presented by GEPCOI (Portuguese Coinfection Study Group)

Abstract

Direct‐acting antiviral drugs (DAAs) have recently changed the paradigm of hepatitis C therapy, significantly improving treatment response rates, patient life expectancy and quality of life. In Portugal, sofosbuvir (SOF) and SOF/ledipasvir (SOF/LDV) were fully reimbursed by the National Health System since early 2015 and generalized use of interferon‐free DAA based regimens became current practice. During 2016, the remaining DAAs were sequentially added and covered by the same health access policy. The Portuguese Study Group of Hepatitis and HIV Co‐infection (GEPCOI) collected data from 15 clinical centres in Portugal, pertaining to the HCV treatment experience with DAA regimens. A cohort of 2133 patients was analysed, representing one of the largest DAA treated HCV/HIV co‐infected individuals. The global sustained virologic response (SVR) achieved was 95% in this real‐life cohort setting. Linear regression analysis showed significant differences in treatment response rates when using SOF plus ribavirin (RBV) combination in genotype 2 or 3 infected individuals (P < .002) and in those with liver cirrhosis (P < .002). These findings corroborate that early treatment is mandatory in HIV/HCV co‐infected patients, as response rates may be negatively influenced by higher fibrosis stages and suboptimal DAA regimens. The current national Portuguese health policy should continue to promote wider treatment access and individualized therapy strategies, aiming at the elimination of HCV infection in this high‐risk co‐infected population.

Real‐world treatment outcomes of sofosbuvir‐based regimens for treatment of chronic hepatitis C with and without human immunodeficiency virus co‐infection

“…Several previously reported studies have shown the same response. 19 , 20 , 21 , 22 , 23 In contrast to our findings, Gayam et al . reported lower rate of SVR in HIV/HCV co‐infection group (84% vs 94%).…”

“…Several previously reported studies have shown the same response. [19][20][21][22][23] In contrast to our findings, Gayam et al reported lower rate of SVR in HIV/HCV co-infection group (84% vs 94%). 24 In this study, the majority of patients was no/mild liver fibrosis by APRI score (68%) and GT1 was predominant genotype (66%), as well as the HIV status was good regarding high CD4 count and low HIV viral load, which may explain the high SVR rate.…”

“…The rate of SVR in real‐world setting was not different between the HCV mono‐infection group and the HIV/HCV co‐infection group (96.9% vs 96.9%, respectively). Several previously reported studies have shown the same response 19–23 . In contrast to our findings, Gayam et al .…”

Hepatitis C continuum of care: Experience of integrative hepatitis C treatment within a human immunodeficiency virus clinic in Indonesia

“…SVR12 for patients using SOF-DCV regimen was achieved by 176 of 184 patients (95.7%). This SVR rate was comparable with rates reported in phase III studies [ 28 ], and other real-life situations in HIV/HCV co-infection [ 15 , 16 , 29 , 30 ], even though HCV genotyping was not a requirement of starting this treatment program. A recent meta-analysis has shown that the SVR12 rate of SOF-DCV±RBV among HIV/HCV co-infected patients in clinical-trials was 97% (95% CI 93–99%), and in real-world studies 94.1% (95% CI 91.2–96.4%) [ 4 ].…”