Treatment of hepatitis C in HIV/HCV co-infected with direct-acting antiviral (DAA) regimens in a single clinic in Tripoli/Libya

Abstract

Background: HIV/HCV co-infection is common in Libya, as the main risk factor is IVDU. Liver cirrhosis can be prevented by HCV eradication. Worldwide, high efficacy of direct acting antivirals (DAA) in the treatment of hepatitis C (HCV) in HIV-1 co-infected patients was reported, however no data available in Libya. We aimed to evaluate the efficacy of DDA in a cohort of HIV co-infected patients. Methods and materials: With intention to treat, we conducted a single center observational study that enrolled all HIV co-infected patients who were presented for HCV treatment from November 2016 to May 2019, we evaluated HIV status, HCV viral load and genotype, and liver status. Treatment success (SVR12) was defined by undetectable HCV-RNA 12 weeks after cessation. Results: A total of 80 HIV/HCV co-infected patients were started treatment of hepatitis C, age ranged from 27 to 69 years (mean 45years), 72 (90%) were males, triple infection reported in 3 (4%). Most of the patients were on antiretroviral therapy, and only 5 (9%) were not on ART drugs. CD4 count was not available in 26patients, >500 in 24 (30%), between 300 to 500 in 13 (16%), and <300 in 17 (21%). HCV genotype 1 found in 44 (55%) patients, genotype 4 &3 found in 20 (25%), and 16 (20%) patients respectively. Naïve patients to HCV treatment were 57 (81%), non-responder and relapse to previous treatment were 7 (9%), and 8 (10%) respectively. Liver cirrhosis by ultrasound abdomen was documented in 21 (26%) patients, APRI score was <.7 in 42 (52.5%), and >.7 in 17 (21%). 6 patients received Interferon in combination with Sofosbuvir and Ribavirin. Interferon free based treatment started in 74 patients (56 received Ledipasvir/Sofosbuvir), 17 received Daclatasvir plus Sofosbuvir, 1 received Sofosbuvir plus Ribavirin), Sustained virological response (SVR) was available in 51 patients, it was achieved in 49/51 (96%). Conclusion: All DAA regimens were well-tolerated and yielded high SVR12 rates in HIV/HCV-co-infected patients, including patients with advanced liver disease and previously non-responder or relapser to interferon and Ribavirin therapy. Treatment of hepatitis C should be offered to all HIV co-infected patients to prevent progression of liver disease to liver cirrhosis and its com.