High efficacy of IFN-free DAA therapy for acute HCV infection in HIV patients

Background and Aims:

Treatment of acute hepatitis C (AHC) with direct-acting antivirals (DAAs) for 6 weeks was highly effective in AHC monoinfection. However, a 6-week treatment duration was suboptimal in HIV/AHC-coinfection. Thus, we evaluated the virological response to different IFN-free DAA regimens in HIV/AHC.

Method:

All patients diagnosed with AHC according to the criteria defined by the European AIDS treatment network (NEAT) since the availability of DAAs were enrolled.

Results:

N = 38 HIV+ patients with AHC and high-risk MSM practices as the main route of transmission (82%, 31/38) were started on IFN-free DAA regimens. The median age was 42.0 years (8.8). HCV Genotype (GT) was predominately GT-1a in 66%(25/38) while GT-1b (11%, n = 4), GT-2 (3%, n = 1), GT-3 (13%, n = 5) and GT-4 (8%, n = 3) were less frequent. At AHC diagnosis, alanine transaminase (ALT) levels (median: 169 IU/mL, IQR: 385) and liver stiffness (LS) values (median: 7.30kPa, IQR: 4.30) were elevated. Most patients (42%; 16/38) received ombitasvir/paritaprevir/ritonavir/dasabuvir, while ombitasvir/paritaprevir/ritonavir, sofosbuvir/ledipasvir, grazoprevir/elbasvir, glecaprevir/pibrentasvir and sofosbuvir/velpatasvir were initiated in 5%(2/38), 13%(5/38), 5%(2/38), 29%(11/38) and 5%(2/38), respectively. All patients were on antiretroviral therapy (ART), mostly on nucleosidic reverse-transcriptase-inhibitors (97%; 37/38) plus integrase-inhibitors (76%; 29/38). ART switch due to potential drug-drug interactions prior to treatment initiation was required in 18%(7/38). Patients received HCV treatment for at least 8 weeks following recommendations for chronic HCV. At the time of data collection, information on SVR4 was available in 87%(33/38) of patients with all (100%) achieving SVR4. Furthermore, all but one patient had ALT levels within normal range at study endpoint while median LS declined from 7.3kPa (4.3) to 6.2kPa (2.88) (p = 0.042).

Conclusions:

In our cohort, treatment with DAA-based regimens achieved 100% SVR4 rates in HIV+ with AHC. HCV-eradication resulted in significant decreases in ALT levels and LS. Future studies should evaluate shorter DAA treatment durations in AHC/HIV coinfection.