Abstract
BackgroundDirect-acting antivirals (DAA) have revolutionized the treatment of chronic hepatitis C patients. However, the real-life data regarding its use in a human immunodeficiency virus (HIV) co-infection from a developing country is lacking. We aimed to see the efficacy of DAA in hepatitis C virus (HCV)/HIV co-infected populations.MethodsIn this prospective, observational, intention-to-treat study from Nepal, treatment-naïve patients undergoing treatment for chronic HCV in HIV co-infected individuals with DAA were studied. Patients on nevirapine were switched to efavirenz or atazanavir. Patients received sofosbuvir/ledipasvir or sofosbuvir/daclatasvir with or without ribavirine. Sustained virological response (SVR) at week 12, adverse events, and treatment compliance were evaluated. Treatment efficacy was compared between cirrhotic and non-cirrhotic patients.ResultsOf 218 patients presenting with an anti-HCV report, 181 (83%) had detectable HCV RNA. Eighty-five (85; 47%) patients were having ART at presentation. Three patients could not complete treatment due to gall stone pancreatitis and 82 completed treatment. Twenty-nine (29; 35%) were cirrhotic at presentation. Fifty-one (51; 62%) patients were genotype 3, 27 (33%) were genotype 1, three (4%) were mixed 1a/3, and one (1%) was 6. Seventy-four (74; 90%) had SVR12. Non-cirrhotics had 96% SVR compared to 79% in cirrhotics. SVR in genotype 3 was 88% while it was 93% in genotype 1.ConclusionsReal-life experience showed that the DAAs are equally effective in HCV HIV co-infected patients. In non-cirrhotic patients, the result is comparable to mono-infected patients. Genotype 3 co-infected are also difficult-to-treat patients. DAA treatment is well-tolerated in HCV/HIV co-infected patients, and there was no dropout during treatment.
Highlights
It is estimated by World Health Organization that there are 35 million people living with human immunodeficiency virus (HIV) globally [1]
Non-cirrhotics had 96% Sustained virological response (SVR) compared to 79% in cirrhotics
Real-life experience showed that the Direct-acting antivirals (DAA) are effective in hepatitis C virus (HCV) HIV co-infected patients
Summary
It is estimated by World Health Organization that there are 35 million people living with human immunodeficiency virus (HIV) globally [1]. The potent and efficacious direct antiviral agent (DAA), which is well-tolerated, has drastically changed the prognosis of chronic hepatitis C (CHC) treatment. The prevalence of HIV/HCV coinfection varies widely by geography and demography. It is consistently high among people who inject drugs (PWID) [8,9]. Direct-acting antivirals (DAA) have revolutionized the treatment of chronic hepatitis C patients. The real-life data regarding its use in a human immunodeficiency virus (HIV) co-infection from a developing country is lacking. We aimed to see the efficacy of DAA in hepatitis C virus (HCV)/HIV co-infected populations
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