Safety and efficacy of ombitasvir - 450/r and dasabuvir and ribavirin in HCV/HIV-1 co-infected patients receiving atazanavir or raltegravir ART regimens.

Joseph J Eron,Jihad Slim,Jay Lalezari,Chia Wang,Yiran B Hu,Linda Fredrick,Melannie Co,Gary Blick,Barbara Da Silva‐Tillmann,Ronald D'Amico,Joseph Gathe,Mark S Sulkowski,Richard Elion,Peter J Ruane,Amit Khatri,Krystal Gibbons,Roger Trinh

doi:10.7448/ias.17.4.19500

Abstract

ObjectiveWhether concomitant HIV antiretroviral therapy (ART) affects the safety and efficacy of interferon-free HCV therapies or whether HCV treatment may negatively affect HIV control is unclear. We assessed the 3 direct-acting antiviral (3D) regimen of ombitasvir, ABT-450 (identified by AbbVie and Enanta; co-dosed with ritonavir) and dasabuvir with ribavirin (RBV) in HCV/HIV-1 co-infected patients with and without cirrhosis, including HCV treatment-experienced, receiving atazanavir (ATV)- or raltegravir (RAL)-based ART therapy.MethodsHCV genotype 1-positive treatment-naïve or pegIFN/RBV-experienced patients, with or without Child-Pugh A cirrhosis, CD4+ count ≥200 cells/mm3 or CD4 + % ≥14%, and plasma HIV-1 RNA suppressed on stable ART received open-label 3D + RBV for 12 or 24 weeks. Rates of HCV-sustained virologic response at post-treatment weeks 4 and 12 (SVR4 and SVR12, respectively) and bilirubin-related adverse events (AEs) are reported from post-hoc analyses for subgroups defined by treatment duration and ART regimen.ResultsThe SVR12 rate for patients receiving 12 weeks of 3D + RBV was 93.5% with comparable rates in patients receiving either ATV (93.8%) or RAL therapy (93.3%) (Table 1). The SVR4 rate for the 24-week arm was 96.9% with a single virologic breakthrough at treatment week 16 in a patient receiving RAL therapy. Patients receiving concomitant ATV had more AEs related to indirect hyperbilirubinemia including ocular icterus, jaundice and grade 3 or 4 elevations in total bilirubin (predominantly indirect). No patient discontinued the study due to AEs, and no serious AEs were reported during or after treatment. No patient had a confirmed plasma HIV-1 RNA value ≥200 copies/mL during the treatment period.ConclusionsIn this first study to evaluate an IFN-free regimen in HCV genotype 1-positive treatment-naïve and experienced patients with HIV-1 co-infection, including those with cirrhosis, high rates of SVR were comparable to those with HCV monoinfection. Indirect hyperbilirubinemia was consistent with the known ABT-450 inhibition of the OATP1B1 bilirubin transporter, RBV-related haemolytic anaemia and inhibitory effect of ATV on bilirubin conjugation. The laboratory abnormalities and AEs observed did not negatively affect treatment response or lead to treatment discontinuation.

Highlights

Parameter, n/N (%) SVR4 SVR12 Adverse events and laboratory abnormalities Ocular icterus Jaundice Total bilirubin Grade 3 Grade 4 Aspartate aminotransferase Grade 3 Grade 4
HCV genotype 1-positive treatment-naıve or pegIFN/RBV-experienced patients, with or without Child-Pugh A cirrhosis, CD4' count ]200 cells/mm3 or CD4 ' % ]14%, and plasma HIV-1 RNA suppressed on stable antiretroviral therapy (ART) received open-label 3 direct-acting antiviral (3D) ' RBV for 12 or 24 weeks
Rates of HCV-sustained virologic response at post-treatment weeks 4 and 12 (SVR4 and SVR12, respectively) and bilirubin-related adverse events (AEs) are reported from post-hoc analyses for subgroups defined by treatment duration and ART regimen

Summary

Introduction

N/N (%) SVR4 SVR12 Adverse events and laboratory abnormalities Ocular icterus Jaundice Total bilirubin Grade 3 Grade 4 Aspartate aminotransferase Grade 3 Grade 4. Safety and efficacy of ombitasvir Á 450/r and dasabuvir and ribavirin in HCV/HIV-1 co-infected patients receiving atazanavir or raltegravir ART regimens MD, Inc., Infectious Disease, Los Angeles, CA, USA.

Results

Conclusion