Abstract
The introduction of the direct-acting antivirals (DAA) has substantially improved the effectiveness of the therapy in patients with chronic hepatitis C. We aimed to compare the efficacy of pangenotypic and genotype-specific DAA in the cohort of genotype (GT) four patients with HCV monoinfection and HIV coinfection. A total of 662 GT4-infected patients treated in 2015–2020—of whom 168 (25.3%) were coinfected with HIV, selected from the retrospective EpiTer-2 database—were enrolled in the analysis. Among HIV-coinfected patients, 54% (90) were treated with genotype-specific regimens and 46% (78) with pangenotypic options, while among HCV-monoinfected patients, the rates were 72% and 28%, respectively. Significantly higher rate of males (67.9% vs. 57.7%, p = 0.01), a lower rate of liver cirrhosis (10.2% vs. 18.1%, p = 0.02), and higher of treatment-naïve patients (87.5% vs. 76.7%, p = 0.003) were documented in the HIV coinfected population. The overall sustained virologic response after exclusion of non-virologic failures was achieved in 98% with no significant difference between HIV-positive and HIV-negative patients, 96.2% vs. 98.5%, respectively. While the genotype-specific regimens resulted in a similar cure rate regardless of the HIV status, the pangenotypic options were more efficacious in patients with HCV monoinfection (99.3% vs. 94.4%, p = 0.05). Hereby, we demonstrated the high effectiveness and good safety profile of the DAA therapy in the population of HCV GT4 infected patients with HIV coinfection supporting the current recommendations to treat HCV/HIV coinfected patients with the same options as those with HCV monoinfection.
Highlights
The hepatitis C virus (HCV)—belonging to the genus Hepacivirus of the family Flaviviridae—is a small, enveloped, single-stranded, positive-sense ribonucleic acid (RNA) virus
The patients included in the current analysis were selected from the EpiTer-2 database (of 13,552 patients treated for chronic hepatitis C in 2015–2020 (Figure 1)
A significantly higher rate of males (67.9% vs. 57.7%, p = 0.01) and a higher percentage of concomitant medications (97.6% vs. 52.2%, p < 0.001) were documented in HCV/human immunodeficiency virus (HIV) coinfected compared to patients with HCV monoinfection, while monoinfected individuals were more frequently diagnosed with comorbidities (59.5% vs. 38.1%, p < 0.001), the statistically significant difference was found for arterial hypertension and kidney diseases (p < 0.001) (Table 1)
Summary
The hepatitis C virus (HCV)—belonging to the genus Hepacivirus of the family Flaviviridae—is a small, enveloped, single-stranded, positive-sense ribonucleic acid (RNA) virus. The most prevalent worldwide is GT1, accounting for nearly 50% of all cases of HCV, followed by the GT3 responsible for 30% of infections; while GT4 with an overall rate of 8% is the third by frequency [1]. The highest prevalence of GT4 is documented in Sub-Saharan and North Africa and the Middle East [1]. The frequency of GT4 infections in Europe varies across countries; a growing prevalence has been observed in recent years in the south of the continent in the Mediterranean Sea region due to immigration [2,3]. An increasing share of GT4 has been documented in Europe in people who inject drugs and patients coinfected with human immunodeficiency virus (HIV) [2,4,5]
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