A Case Series of HCV Genotype 1a Infection Patients With HIV Co-infection Treated With 8 Weeks of Ledipasvir-Sofosbuvir

Abstract

HIV (human immunodeficiency virus) co-infection in hepatitis C virus (HCV) patients increases the risk of liver fibrosis and hepatic decompensation. The current American Association For The Study of Liver Disease (AASLD) guidelines recommend a 12-week course of Ledipasvir-Sofosbuvir for HCV/HIV co-infection. We present a case series of four HCV patients with HIV co-infection treated with 8 weeks of therapy. A total of seventy-seven patients with HCV and HIV co-infection were seen in our clinic between May 2014 to May 2017. Four patients (n=4) with HCV genotype 1a and HIV co-infection were effectively treated with 8 weeks of Ledipasvir-Sofosbuvir. SVR was achieved after initial 4 weeks of therapy, and viral load continued to be undetectable at 8,12,16,24 and 28 weeks post treatment. All patients were African American. Three patients had history of intra-venous drug abuse and one out of three patients was actively using cocaine. One patient was a homosexual male. At the time of initiation of therapy all patients were immune to hepatitis A and B. HCV viral load was below 1 million IU/ml for 3 patients and 3602676 IU/ml for one patient. Fibrosure testing revealed stages F2(n=1) and F3(n=3). All patients were concurrently treated for HIV with antiretroviral therapy including Efavirenz / Emtricitabine / Tenofovir (n=3) and Emtricitabine/Rilpivirine/Tenofovir (n=1). Ledipasvir-sofosbuvir for 8 weeks with intensive monitoring of medication compliance provides a safe and highly effective treatment for patients co-infected with HCV genotype 1a and HIV. A shorter duration of therapy can lead to signficant cost reduction in treatment and improve compliance for particular HCV/HIV co-infected patients. Prospective trials with a large number of patients are needed to identify the type of patients, which might benefit from shorter courses of therapy.