DAAs Stay Effective For HCV/HIV Co-infection

NOVEMBER 20, 2017
Gail Connor Roche
Sammy Saab, MDSammy Saab, MD, MPH, AGAF, FAASLD, FACG
Patients co-infected with the hepatitis C (HCV) and human immunodeficiency (HIV) viruses can experience cure rates similar to individuals infected with HCV alone when both groups receive direct-acting antiviral (DAA) drugs, research shows.
           
Before DAAs, sustained virologic response (SVR) rates were significantly lower for co-infected patients taking interferon-based therapies when compared to HCV patients without HIV.
           
With the antivirals, SVR rates for both mono-infected and co-infected individuals were greater than 93%, a team from the University of California at Los Angeles found. The research was published Nov. 6 in the journal Hepatology.
           
“The HCV cure rate in co-infected patients can be as high as HCV mono-infected patients,” corresponding author Sammy Saab, a professor of medicine and surgery at the David Geffen School of Medicine at UCLA, told MD Magazine.
           
Historically, HCV patients co-infected with HIV have faced many obstacles. They had high treatment ineligibility because of concurrent medical and psychiatric conditions, non-adherence to doctor visits, medication intolerance and substance abuse, the researchers noted.

They generally received less treatment than mono-infected individuals and faced low SVR rates when prescribed interferon, the team said.
           
“Patients co-infected with HIV-HCV always had suboptimal cure rates with interferon-based therapy,” said UCLA’s Saab, MD, MPH, AGAF, FAASLD, FACG.
           
Because of these hurdles, the US Food and Drug Administration (FDA) identified individuals with HIV and HCV co-infection as a specific population with unmet medical needs.      
           
Now, the researchers contend that such a designation should be reevaluated because of the high cure rates offered by DAAs.

“HIV/HCV co-infected patients can be included in HCV mono-infected studies,” Saab said. “This will help prevent access delay in the new HCV therapies for co-infected patients.”

To study whether DAA drugs were having an impact on the HIV/HCV co-infected population, a team headed by lead author Cameron Sikavi at Harbor-UCLA Medical Center, reviewed studies and research from January 2004 to July 2017.

They found several large, recent trials that demonstrated SVR rates of greater than 93% with DAA treatments. The drugs included ledipasvir/sofosbuvir (Harvoni) and other antiviral medications.

Co-infected patients on DAAs also reported improvements in general health and well-being consistent with patients with HCV alone, the researchers said.
           
When explaining why DAAs would provide such benefits in HIV/HCV co-infections when interferon-based therapies did not, Saab said inferferon works by “stimulating the immune system to fight off the HCV infection.”

Patients with HIV, however, may not be able to mount a necessary response to interferon to cure HCV, he said.

“In contrast, DAAs directly affect viral replication,” Saab said. “DAAs are also much better tolerated, which leads to improved adherence and completion of therapy.”
           
Saab noted that the biggest current limitation to treating co-infected patients is the potential for detrimental drug interactions between HIV and HCV medicines.
           
“Fortunately, many of these can be easily overcome because of multitude of both HIV and HCV medications,” he said.
           
Saab suggested the next field of research should pertain to screening rates.

“The biggest barrier to a cure is knowing who is infected,” Saab said. “More research is needed to improve screening programs in the United States.”

The study, "Hepatitis C and Human Immunodeficiency Virus Co-Infection in the Era of Direct-Acting Antiviral Agents: No Longer A Difficult to Treat Population," was published online in Hepatology last week.

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