Effectiveness and Safety of Interferon-Free Direct-Acting Antiviral Hepatitis C Virus Therapy in HIV/Hepatitis C Virus Coinfected Individuals: Results From a Pan-European Study

Abstract

Objectives: To investigate the effectiveness, safety and reasons for premature discontinuation of directacting antivirals (DAAs) in a diverse population of HIV/HCV co-infected individuals in Europe.Methods: All HIV/HCV co-infected individuals in the EuroSIDA study that started interferon (IFN) free DAA treatment between 1/6/2014 and 1/3/2018 with ≥12 weeks of follow-up after treatment stop were included in this analysis. Sustained virological response (SVR) was defined as a negative HCV-RNA result ≥12 weeks after stopping treatment (SVR12). Logistic regression was used to explore factors associated with SVR12.Results: 1042 individuals started IFN-free DAA treatment after 1/6/2014 and were included, 862 (82.2%) had a known response to treatment, 789 (91.5%, 95% CI 89.7-93.4) of which achieved SVR12. There were no differences in SVR12 across regions of Europe (p=0.84). After adjustment, the odds of achieving SVR12 was lower in individuals that received sofosbuvir/simeprevir +/-RBV (aOR 0.21 (95% CI 0.08-0.53) or ombitasvir/paritaprevir/dasabuvir +/-RBV (aOR 0.46 (95% CI 0.22-1.00) compared to sofosbuvir/ledipasvir +/-RBV. 43 (4.6%) individuals had one or more components of their HCV regimen stopped early, most commonly due to toxicity (n=14); of these 14, 11 were treated with ribavirin. Increased bilirubin was the most common grade 3 or 4 laboratory adverse event (n=15.3%) and was related to treatment with atazanavir and ribavirin.Conclusions: Our findings from real-world data on HIV/HCV co-infected individuals across Europe show DAA treatment is well tolerated, and that high rates of SVR12 can be achieved in all regions of Europe.

Hepatitis C Virus Treatment Response to Direct-acting Antivirals Among Adolescents With HIV/HCV Coinfection: Real-world Data From Ukraine

“…3,4 Although there is substantial real-world evidence on DAA use in adults coinfected with HIV/HCV with high cure rates, DAAs have not yet been widely used in coinfected children and adolescents. 5 Adults and children with HIV/HCV coinfection have more progressive liver disease than their mono-HCV infected counterparts, and lower success with pegylated-interferon/ribavirin treatment, and are considered a priority group for DAA treatment. 1,4,6,7 Data on real-world use of DAAs in adolescents is largely limited to Egypt and Western European settings and has been focused on HCV monoinfected adolescents.…”

Cost‐effectiveness of hepatitis C virus test‐and‐treat and risk reduction strategies among men who have sex with men living with HIV in France

“…We considered risk reduction levels of 15% and 10% instead of 20%. Although recent studies assessing the efficacy of DAA therapy among individuals co-infected with HIV in real-world settings indicate SVR rates of 95% or less [37], we explored the impact of assuming a 98% SVR rate from 2019 for those treated in disease stages preceding cirrhosis. We performed an analysis with assortative mixing.…”

Long‐term trends in hepatitis C prevalence, treatment uptake and liver‐related events in the Swiss HIV Cohort Study

“…5 In real-life settings, DAAs have been shown to be highly effective and safe for people with HIV and HCV coinfection. 6 However, the availability of these drugs is limited due to their high cost and missing insurance-coverage. 7 Additionally, lack of harm reduction measures for PWID, such as needle exchange programs, might further hinder HCV elimination.…”

“…The development of second‐generation direct acting antivirals (DAAs) has revolutionized HCV‐care allowing for short treatment durations with very few adverse events and cure rates of >95% 5 . In real‐life settings, DAAs have been shown to be highly effective and safe for people with HIV and HCV coinfection 6 . However, the availability of these drugs is limited due to their high cost and missing insurance‐coverage 7 .…”