Differing Results: HIV and HCV Coinfection and How It Affects Direct-Acting Antivirals

Two studies produce two very different results treating a hepatitis C-HIV coinfection.

Two studies presented at The International Liver Congress found conflicting results in regards to whether or not coinfections of hepatitis C virus (HCV) and HIV impact the efficacy of direct-acting antivirals (DAAs).

In a cohort study from Spain, researchers have found HIV negatively effects the response rate of DAAs in people with an HCV coinfection.

The study included 1276 patients throughout 33 hospitals in Spain.

Data showed an 11% lower rate of achieving a sustained viral response in 12 weeks (SVR12) among patients taking interferon-based DAAs with a HIV and HCV coinfection compared to patients with HCV monoinfection.

Coinfected patients taking interferon-free DAAs had a 6% lower rate of achieving SVR12 compared to patients with HCV monoinfection.

"Our study demonstrates the impact of HIV co-infection on the effectiveness of DAA-based treatment," said Karin Neukam, PhD, stated in a press release. "We must keep a close eye on co-infected patients to ensure that they receive the treatment they need."

A real-world retrospective study conducted in the United States found different results.

This study was conducted with 408 patients who were predominantly of genotype 1 (GT 1=79%).

Researchers found SVR12 rates over 88% post treatment with combinations of simeprevir and sofosbuvir, ledipasvir and sofosbuvir, or ombitsavir, paritaprevir, ritonavir and dasabuvir.

Logistic regression analysis controlling was used to account for patient demographics, disease severity, and other comorbidities.

Study authors concluded that there was no statistically significant impact of HIV coinfection on DAAs.

"Our analysis showed that across the three treatments in our study, there was no statistically significant impact of HIV co-infection on the effectiveness of the DAAs," said study author Justin McGinnis. "We know that these patients are at increased risk of liver disease progression from their HCV status, and these data suggest the co-infected patient group could benefit from treatment."

Since both studies produced very different results, more research needs to be conducted.

"These differing data confirm that the study of HCV treatment in HIV co-infected patients remains an interesting and valuable subject for study," said professor Laurent Castera, MD, PhD stated. "More research is needed to come to a viable resolution so we can provide the best care for these co-infected patients."