2236. Direct-Acting Antivirals: Efficacy in a Real-World, Urban, Undeserved, HIV-HCV Co-Infected Population

Abstract

BackgroundClinical trials demonstrated high sustained virologic response (SVR) rates for HIV-HCV co-infected patients treated for HCV with direct-acting antivirals (DAAs). SVR data for real-world cohorts are increasingly available, yet limited in underserved populations. Individual and systematic barriers can limit treatment success in underserved patient populations.MethodsInvestigators performed a retrospective cohort study of HIV-HCV co-infected adult patients treated with DAAs in a hepatology clinic and an infectious disease clinic network within an urban, academic medical center from February 2, 2014 to March 13, 2018. Patients were treated by multidisciplinary teams including clinical pharmacists. DAA selection was based on the American Association for the Study of Liver Disease and Infectious Diseases Society of America HCV Guidance and the patient’s insurance formulary at the time of treatment. For DAA-experienced patients, results from the most recent DAA course were included. The primary outcome was SVR at 12 weeks after HCV treatment completion. Descriptive statistics were utilized to analyze data.ResultsSeventy-one patients started HCV treatment. SVR data were available for 62 patients. Of those, the majority were Black (68%), genotype 1a (76%), cirrhotic (50%), HCV treatment-naïve (66%), on HIV antiretrovirals (97%), and insured through Medicare or Medicaid (66%). Mean age was 59 (±8) years. Ledipasvir/sofosbuvir (LDV/SOF) was the most commonly used DAA regimen (65%). Overall SVR rate for all regimens was 94% (58/62 patients). SVR by DAA regimen was 75% for LDV/SOF + ribavirin (3/4), 93% for LDV/SOF (37/40), and 100% for simeprevir + SOF (6/6), SOF/velpatasvir (6/6), elbasvir/grazoprevir (4/4), and SOF + ribavirin (2/2). The four treatment failures were cirrhotic patients with genotype 1a or 1b; three were treatment-naïve and one was DAA-experienced.ConclusionIn our urban, underserved HIV-HCV co-infected population, HCV treatment with DAAs by multidisciplinary teams including clinical pharmacists resulted in high SVR rates that were numerically comparable to SVR rates achieved in co-infection clinical trials.Disclosures R. Burgos, Gilead Sciences: Scientific Advisor in 2015, Consulting fee; Merck & Co., Inc.: Investigator, Research support. M. Martin, Gilead: Scientific Advisor and Shareholder, Consulting fee and Research grant; Merck: Shareholder, N/A; AbbVie: Shareholder, N/A.