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Marquez LK, Ingiliz P, Boesecke C, Krznaric I, Schewe K, Lutz T, Mauss S, Christensen S, Rockstroh JK, Jain S, He F, Wertheim JO, Martin NK. Establishing a framework towards monitoring HCV microelimination among men who have sex with men living with HIV in Germany: A modeling analysis. PLoS One 2022; 17:e0267853. [PMID: 35551326 PMCID: PMC9098082 DOI: 10.1371/journal.pone.0267853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/16/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Prior to direct-acting antivirals (DAAs), HCV incidence rose among men who have sex with men (MSM) living with HIV infection in Germany despite high hepatitis C virus (HCV) treatment rates. We establish a HCV elimination modeling framework to evaluate whether existing treatment rates can achieve the World Health Organization (WHO) incidence target among MSM living with HIV in Germany. METHODS To evaluate progress towards HCV elimination in Germany, we adapted a previously published HCV transmission model among MSM living with diagnosed HIV. We modelled HCV incidence and prevalence until 2030 (relative to 2015) under existing treatment and DAA scale-up and explored potential impacts of disruptions in treatment and behavioral risk reduction due to the COVID-19 pandemic. RESULTS Continuing current treatment rates will result in stable HCV incidence among MSM living with HIV in Germany between 2015-2030. The WHO HCV incidence target is achievable under DAA scale-up to 100% treatment combined with treatment of those previously diagnosed and untreated (at a rate of 15%/year) and would result in greater reductions with early treatment (3 vs 6 months) reducing incidence from 4.0/100person-years to 0.8/100person-years by 2030. A 12-month disruption to HCV treatment (20% reduction) and risk behaviors (25%,50%,75% reduction) during the COVID-19 pandemic would result in a 15% relative increase in total HCV incidence in 2030 compared to that expected under the status quo. CONCLUSIONS HCV elimination among MSM living with HIV in Germany requires further DAA scale-up among those newly diagnosed combined with efforts to treat those previously diagnosed but untreated. Prospective monitoring will establish whether Germany is on track for HCV microelimination.
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Affiliation(s)
- Lara K Marquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States of America
| | - Patrick Ingiliz
- Center for Infectiology, Berlin, Germany
- Hepatology Department, Henri-Mondor Hospital, INSERM U955, Créteil, France
| | | | | | | | | | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Duesseldorf, Germany
| | - Stefan Christensen
- CIM Münster, Münster, Germany
- Department of Gastroenterology and Hepatology, Muenster University Hospital, Muenster, Germany
| | | | - Sonia Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States of America
| | - Feng He
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States of America
| | - Joel O Wertheim
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States of America
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA, United States of America
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Martin NK, Jansen K, An der Heiden M, Boesecke C, Boyd A, Schewe K, Baumgarten A, Lutz T, Christensen S, Thielen A, Mauss S, Rockstroh JK, Skaathun B, Ingiliz P. Eliminating Hepatitis C Virus Among Human Immunodeficiency Virus-Infected Men Who Have Sex With Men in Berlin: A Modeling Analysis. J Infect Dis 2020; 220:1635-1644. [PMID: 31301142 DOI: 10.1093/infdis/jiz367] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 07/11/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite high hepatitis C virus (HCV) treatment rates, HCV incidence among human immunodeficiency virus (HIV)-infected men who have sex with men (HIV-infected MSM) in Germany rose before HCV direct-acting antivirals (DAAs). We model what intervention can achieve the World Health Organization (WHO) elimination target of an 80% reduction in HCV incidence by 2030 among HIV-infected MSM in Berlin. METHODS An HCV transmission model among HIV-diagnosed MSM was calibrated to Berlin (rising HCV incidence and high rates of HCV testing and treatment). We modeled the HCV incidence among HIV-diagnosed MSM in Berlin until 2030 (relative to 2015 WHO baseline) under scenarios of DAA scale-up with or without behavior change (among HIV-diagnosed MSM and/or all MSM). RESULTS Continuing current treatment rates will marginally reduce the HCV incidence among HIV-diagnosed MSM in Berlin by 2030. Scaling up DAA treatment rates, beginning in 2018, to 100% of newly diagnosed HCV infections within 3 months of diagnosis and 25% each year of previously diagnosed and untreated HCV infections could reduce the HCV incidence by 61% (95% confidence interval, 55.4%-66.7%) by 2030. The WHO target would likely be achieved by combining DAA scale-up with a 40% reduction in HCV transmission among HIV-diagnosed MSM and a 20% reduction among HIV-undiagnosed or HIV-uninfected MSM. DISCUSSION HCV elimination among HIV-infected MSM in Berlin likely requires combining DAA scale-up with moderately effective behavioral interventions to reduce risk among all MSM.
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Affiliation(s)
- Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego
| | | | | | | | - Anders Boyd
- INSERM, Paris, Institut Pierre Louis d'Epidémiologie et de Santé Publique, France.,Department of Infectious Diseases, Research and Prevention, Public Health Service of Amsterdam, Netherlands
| | - Knud Schewe
- Infektionsmedizinisches Centrum Hamburg, Germany
| | | | | | | | | | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Duesseldorf, Germany
| | | | - Britt Skaathun
- Division of Infectious Diseases and Global Public Health, University of California San Diego
| | - Patrick Ingiliz
- Center for Infectiology, Berlin, Germany.,Department of Hepatology and Gastroenterology, Charité University Medical Center Berlin, Germany
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Tolentino B, Singh RR, Misra S, Dieterich DT, Sarpel D. An update on the management of hepatitis C virus and human immunodeficiency virus co-infection. Future Virol 2019. [DOI: 10.2217/fvl-2018-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An estimated 2.3 million people globally are co-infected with HIV and HCV. Liver disease is now a leading cause of non-AIDS-related mortality among HIV-infected patients. The development of direct-acting antiviral agents has revolutionized the treatment of HIV/HCV co-infection with sustained virologic response response rates above 95% in most patient populations. This article provides an update on the management of acute and chronic HCV in patients co-infected with HIV including a section on drug–drug interactions.
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Affiliation(s)
- Bryan Tolentino
- Department of Medicine, Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ritu R Singh
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Suresh Misra
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Douglas T Dieterich
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Dost Sarpel
- Department of Medicine, Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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Misra S, Dieterich DT, Saberi B, Kushner T. Direct-acting antiviral treatment of acute hepatitis C virus infections. Expert Rev Anti Infect Ther 2018; 16:599-610. [PMID: 30067402 DOI: 10.1080/14787210.2018.1505502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Hepatitis C contributes to significant morbidity and mortality worldwide. AHCV is defined as documented infection within 6 months of exposure. Treating acute hepatitis C virus (AHCV) with direct-acting antiviral agents in persons who inject drugs, HIV-positive men who have sex with men, and patients who acquire HCV nosocomially can contribute to the elimination of disease globally, preclude the morbidity and mortality of chronic disease, and prevent further transmission. Areas covered: In this review, we describe the epidemiology of AHCV, its natural history, the considerations involved in the decision of whether to treat AHCV, and the most current DAA therapy guidelines. PubMed was queried using key words and bibliographies were evaluated for relevant articles. Expert commentary: Despite the obvious benefits of AHCV treatment, clinical management is limited by the ability to identify asymptomatic cases and the absence of fully supported guidelines. However, clinical research is advancing and identifying specific regimens, decreasing treatment durations, and creating strategies to target at risk groups and screen for AHCV.
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Affiliation(s)
- Suresh Misra
- a Division of Liver Diseases, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Douglas T Dieterich
- a Division of Liver Diseases, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Behnam Saberi
- a Division of Liver Diseases, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Tatyana Kushner
- a Division of Liver Diseases, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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Jagjit Singh GK, Kaye S, Abbott JC, Boesecke C, Rockstroh J, McClure MO, Nelson M. Use of next-generation sequencing in the CHAT study (acute HCV in HIV): effect of baseline resistance-associated NS3 variants on treatment failure. HIV CLINICAL TRIALS 2018; 19:46-51. [PMID: 29493385 DOI: 10.1080/15284336.2018.1439714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background The epidemic of acute HCV infection among HIV-infected men who have sex with men (MSM) is ongoing. Transmission of drug-resistant variants (DRVs) after HCV treatment failure could pose a major threat to the effectiveness of future therapies. We determined the baseline prevalence of pre-existing DRVs in the HCV NS3 protease gene and their effects on the addition of telaprevir (TVR) to standard pegylated interferon and ribavirin (PEG-IFN/RBV) for acute HCV infection in individuals enrolled in a multicentre randomized controlled trial (2013 and 2014). Methods The HCV NS3 viral protease was analyzed using Sanger and next-generation sequencing (NGS) for DRVs at baseline (n = 31), and at viral breakthrough following TVR-based treatment (n = 3) or PEG-IFN/RBV alone (n = 2). Results Sequence analysis indicated that all individuals were infected with HCV genotype 1a. Complete (100%) concordance was seen between Sanger and NGS for high levels of mutant viral populations. The simeprevir-associated Q80K variant was present at high frequency in the German samples (7/11-64%) and infrequently in the UK samples (1/20-5%). In the three TVR-based treatment failures, V36M/l and R155K/T emerged, but not R155G which was detectable at low levels in two individuals at baseline. Failure rate at week 24 was 26.7% (with baseline DRVs) vs. 6.3% (without baseline DRVs), p = 0.17). Comparison of sequences pre- and post-therapy in 5 who failed therapy revealed the emergence of not previously described variants V193G, E176K, P189S (on TVR), and V181S in one instance each. Conclusion The presence of baseline DRVs for the NS3 protease gene of HCV genotype 1a did not appear to predict treatment failure in our patient cohort. Where detected, Q80K was present at high levels (>98%), but had no effect on outcomes and remained high after failure.
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Affiliation(s)
- Gurmit Kaur Jagjit Singh
- a Department of HIV and Sexual Health , Chelsea and Westminster Hospital NHS Foundation Trust , London , UK
| | - Steve Kaye
- b Division of Infectious Diseases , Imperial College London , London , UK
| | - James C Abbott
- c Department of Surgery and Cancer , Imperial College London , London , UK
| | | | - Juergen Rockstroh
- d Department of Medicine , Bonn University Hospital , Bonn , Germany
| | - Myra O McClure
- b Division of Infectious Diseases , Imperial College London , London , UK
| | - Mark Nelson
- a Department of HIV and Sexual Health , Chelsea and Westminster Hospital NHS Foundation Trust , London , UK.,b Division of Infectious Diseases , Imperial College London , London , UK
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Lampejo T, Agarwal K, Carey I. Interferon-free direct-acting antiviral therapy for acute hepatitis C virus infection in HIV-infected individuals: A literature review. Dig Liver Dis 2018; 50:113-123. [PMID: 29233687 DOI: 10.1016/j.dld.2017.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 10/29/2017] [Accepted: 11/15/2017] [Indexed: 02/07/2023]
Abstract
Dramatic rises in hepatitis C virus (HCV) coinfection rates in human immunodeficiency virus (HIV)-infected individuals have been observed recently, largely attributable to increasing recreational drug use combined with increased testing for HCV. In the era of direct-acting antiviral (DAA) therapy, treatment of acute HCV infection in HIV-infected individuals with short durations of these drugs may potentially reduce the disease and economic burden associated with HCV infection as well as reducing the likelihood of onward HCV transmission. We performed an extensive literature search of PubMed, Embase and Google Scholar up to 05 September 2017 for clinical trials of acute HCV infection in HIV-infected individuals. In the studies identified, rates of sustained virologic response at 12 weeks post-treatment (SVR12) ranged from 21% with 6 weeks of therapy up to 92% with 12 weeks of therapy with sofosbuvir and ribavirin. Ledipasvir/sofosbuvir for 6 weeks achieved an SVR of 77%. No HIV-related events occurred regardless of whether patients were receiving antiretroviral therapy (ART) and DAAs were well tolerated. Data is currently limited with regards to optimal regimens and durations of therapy, which need to be tailored based on potential interactions with concurrent ART and consideration for the fact that patients with higher baseline HCV RNA levels may require an extended duration of treatment.
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Affiliation(s)
- Temi Lampejo
- Institute of Liver Studies, King's College Hospital, London, United Kingdom.
| | - Kosh Agarwal
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Ivana Carey
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
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Gaeta GB, Puoti M, Coppola N, Santantonio T, Bruno R, Chirianni A, Galli M. Treatment of acute hepatitis C: recommendations from an expert panel of the Italian Society of Infectious and Tropical Diseases. Infection 2017; 46:183-188. [PMID: 29238918 DOI: 10.1007/s15010-017-1107-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 12/04/2017] [Indexed: 12/24/2022]
Abstract
AIM This paper is aimed at providing practical recommendations for the management of acute hepatitis C (AHC). METHODS This is an expert position paper based on the literature revision. Final recommendations were graded by level of evidence and strength of the recommendations. RESULTS Treatment of AHC with direct-acting antivirals (DAA) is safe and effective; it overcomes the limitations of INF-based treatments. CONCLUSIONS Early treatment with DAA should be offered when available.
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Affiliation(s)
- Giovanni B Gaeta
- Infectious Diseases, Campania University "Luigi Vanvitelli", Naples, Italy.
| | - Massimo Puoti
- Infectious Diseases, Niguarda Hospital, Milan, Italy
| | - Nicola Coppola
- Infectious Diseases, Campania University "Luigi Vanvitelli", Naples, Italy
| | | | | | | | - Massimo Galli
- Infectious Diseases, University of Milan, Milan, Italy
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8
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Malta F, Gaspareto KV, Lisboa-Neto G, Carrilho FJ, Mendes-Correa MC, Pinho JRR. Prevalence of naturally occurring NS5A resistance-associated substitutions in patients infected with hepatitis C virus subtype 1a, 1b, and 3a, co-infected or not with HIV in Brazil. BMC Infect Dis 2017; 17:716. [PMID: 29132303 PMCID: PMC5683373 DOI: 10.1186/s12879-017-2817-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 11/05/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Non-structural 5A protein (NS5A) resistance-associated substitutions (RASs) have been identified in patients infected with hepatitis C virus (HCV), even prior to exposure to direct-acting antiviral agents (DAAs). Selection for these variants occurs rapidly during treatment and, in some cases, leads to antiviral treatment failure. DAAs are currently the standard of care for hepatitis C treatment in many parts of the world. Nevertheless, in Brazil, the prevalence of pre-existing NS5A RASs is largely unknown. In this study, we evaluated the frequency of naturally occurring NS5A RASs in Brazilian patients infected with HCV as either a monoinfection or coinfection with human immunodeficiency virus (HIV). METHODS Direct Sanger sequencing of the NS5A region was performed in 257 DAA-naïve patients chronically infected with HCV (156 monoinfected with HCV and 101 coinfected with HIV/HCV). RESULTS The frequencies of specific RASs in monoinfected patients were 14.6% for HCV GT-1a (M28 V and Q30H/R), 6.0% for GT-1b (L31F/V and Y93H), and 22.6% for GT-3a (A30K and Y93H). For HIV/HCV-coinfected patients, the frequencies of RAS were 3.9% for GT-1a (M28 T and Q30H/R), and 11.1% for GT-1b (Y93H); no RASs were found in GT-3a sequences. CONCLUSIONS Substitutions that may confer resistance to NS5A inhibitors exist at baseline in Brazilian DAA-naïve patients infected with HCV GT-1a, -1b, and -3a. Standardization of RAS definitions is needed to improve resistance analyses and to facilitate comparisons of substitutions reported across studies worldwide. Therapeutic strategies should be optimized to efficiently prevent DAA treatment failure due to selection for RASs, especially in difficult-to-cure patients.
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Affiliation(s)
- Fernanda Malta
- Institute of Tropical Medicine, LIM-07, University of São Paulo, Av. Dr. Enéas Carvalho Aguiar, 500 – 2nd floor IMT-II, São Paulo, SP 05403-000 Brazil
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Karine Vieira Gaspareto
- Institute of Tropical Medicine, LIM-07, University of São Paulo, Av. Dr. Enéas Carvalho Aguiar, 500 – 2nd floor IMT-II, São Paulo, SP 05403-000 Brazil
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Gaspar Lisboa-Neto
- Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Flair José Carrilho
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Maria Cássia Mendes-Correa
- Department of Infectious Diseases, University of São Paulo School of Medicine, São Paulo, Brazil
- Institute of Tropical Medicine, LIM-52, University of São Paulo, São Paulo, SP Brazil
| | - João Renato Rebello Pinho
- Institute of Tropical Medicine, LIM-07, University of São Paulo, Av. Dr. Enéas Carvalho Aguiar, 500 – 2nd floor IMT-II, São Paulo, SP 05403-000 Brazil
- Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
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Boesecke C, Singh GKJ, Scholten SHA, Lutz T, Baumgarten A, Schneeweiss SM, Trein A, Rausch M, Ingiliz P, Rockstroh JK, Nelson M. Telaprevir-Containing Triple Therapy in Acute HCV Coinfection: The CHAT Study. Antivir Ther 2017; 22:619-623. [DOI: 10.3851/imp3143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2017] [Indexed: 10/20/2022]
Abstract
Background No published randomized controlled data on the use of direct-acting antivirals (DAA) in acute hepatitis C (AHC) coinfection exist. However, with the AHC epidemic ongoing among men who have sex with men (MSM) these are urgently needed. Methods The CHAT study is a randomized controlled trial of pegylated interferon + ribavirin (PR) plus telaprevir (TVR) for 12–24 weeks versus PR alone for 24–48 weeks in the response-guided treatment of patients with AHC genotype (GT) 1 infection and HIV-1 coinfection in Germany and Great Britain. Results 34 patients were included: 15 were randomized to the PR arm (arm 1), 19 to the TVR + PR arm (arm 2). All patients were MSM, median age was 40 years. 55% had IL28B C/C GT. Median baseline HCV RNA was 291,227 IU/ml, median alanine aminotransferase was 105 U/l. 85% received cART, all had baseline HIV RNA <40 copies/ml. Overall sustained virological response (SVR12) rate was 79.4% (27/34). SVR12 was seen in 12/15 (80%) in arm 1 and in 15/19 (79.8%) in arm 2. Of the four patients without SVR in arm 2, one experienced viraI breakthrough, two were non-responders; in one case HCV protease inhibitor (PI)-associated mutations were selected under TVR (V36M, R155K). Conclusions Due to moderate response rates and additional toxicities 1st generation HCV PIs should not be used in treating acute HCV. While not being licensed, recent study data and guidelines support the use of dual DAA therapy but optimal treatment duration in acute HCV needs further investigation.
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Affiliation(s)
| | - Christoph Boesecke
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner Site Cologne-Bonn, Bonn, Germany
| | | | | | | | | | - Stephan M Schneeweiss
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
- Praxis Hohenstaufenring, Cologne, Germany
| | - Andreas Trein
- Gemeinschaftspraxis Schwabstrasse, Stuttgart, Germany
| | | | | | - Jürgen K Rockstroh
- Department of Medicine I, Bonn University Hospital, Bonn, Germany
- German Centre for Infection Research (DZIF), Partner Site Cologne-Bonn, Bonn, Germany
| | - Mark Nelson
- Chelsea and Westminster Hospital, London, UK
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Rockstroh JK, Bhagani S, Hyland RH, Yun C, Dvory-Sobol H, Zheng W, Brainard DM, Ingiliz P, Lutz T, Boesecke C, Nelson M. Ledipasvir-sofosbuvir for 6 weeks to treat acute hepatitis C virus genotype 1 or 4 infection in patients with HIV coinfection: an open-label, single-arm trial. Lancet Gastroenterol Hepatol 2017; 2:347-353. [PMID: 28397698 DOI: 10.1016/s2468-1253(17)30003-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/06/2017] [Accepted: 01/10/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND The latest European Association for the Study of the Liver (EASL) guidelines now recommend that patients with acute hepatitis C virus (HCV) infection should be treated with a combination of sofosbuvir and an NS5A inhibitor for 8 weeks. However, the ideal duration of treatment with interferon-free regimens, particularly in HIV-coinfected individuals, remains unknown. We assessed the efficacy and safety of 6 weeks of ledipasvir-sofosbuvir for acute genotype 1 or 4 HCV in HIV-1-coinfected patients. METHODS This open-label, single-arm trial, done in Germany and the UK, included patients with acute HCV genotype 1 or 4 and HIV-1. At screening, patients were either receiving HIV antiretrovirals and had HIV RNA less than 200 copies per mL, or not receiving antiretrovirals and had a CD4 T-cell count of greater than 500 cells per μL. All patients received ledipasvir-sofosbuvir once daily for 6 weeks. The primary efficacy endpoint was the proportion of patients with sustained virological response 12 weeks after the end of treatment (SVR12). This study is registered with ClinicalTrials.gov, number NCT02457611. FINDINGS Between June 11, 2015, and Jan 8, 2016, we enrolled and treated 26 patients. All (100%) were men, 24 (92%) were white, and 25 (96%) were receiving antiretroviral treatment. 19 (73%) had genotype 1a and seven (27%) had genotype 4 HCV. Overall, 20 (77%; 95% CI 56-91) of 26 patients achieved SVR12: 15 (79%) of 19 with genotype 1a, and five (71%) of seven with genotype 4. Of six patients not achieving SVR12, three relapsed, two achieved sustained virological response 4 weeks after the end of treatment but were lost to follow-up, and one was reinfected. The most common adverse events were fatigue (seven participants [27%]), nasopharyngitis (seven [27%]), and headache (six [23%]). No patient discontinued or interrupted therapy due to adverse events. No HIV rebound occurred during the study. INTERPRETATION The rate of cure with a fixed-dose combination of ledipasvir-sofosbuvir for patients with acute genotype 1 or 4 HCV infection and HIV-1 coinfection is similar to historic rates with interferon-based treatment, but with shorter treatment duration and more favourable safety outcomes. FUNDING Gilead Sciences.
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Affiliation(s)
| | | | | | | | | | - Wei Zheng
- Gilead Sciences, Foster City, CA, USA
| | | | | | - Thomas Lutz
- Infektiologikum, Frankfurt/Main, Frankfurt, Germany
| | | | - Mark Nelson
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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11
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Ingiliz P, Martin TC, Rodger A, Stellbrink HJ, Mauss S, Boesecke C, Mandorfer M, Bottero J, Baumgarten A, Bhagani S, Lacombe K, Nelson M, Rockstroh JK. HCV reinfection incidence and spontaneous clearance rates in HIV-positive men who have sex with men in Western Europe. J Hepatol 2017; 66:282-287. [PMID: 27650285 DOI: 10.1016/j.jhep.2016.09.004] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 08/30/2016] [Accepted: 09/07/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Moderate cure rates of acute hepatitis C virus (HCV) infections with pegylated interferon and ribavirin have been described in the last decade in men who have sex with men (MSM), who are also coinfected with the human immunodeficiency virus (HIV). However, a subsequent high incidence of HCV reinfections has been reported regionally in men who both clear the infection spontaneously or who respond to treatment. METHODS Retrospective analysis of reinfections in HIV infected MSM in eight centers from Austria, France, Germany, and the UK within the NEAT network between May 2002 and June 2014. RESULTS Of 606 individuals who cleared HCV spontaneously or were successfully treated, 149 (24.6%) presented with a subsequent HCV reinfection. Thirty out of 70 (43%) who cleared again or were successfully treated, presented with a second reinfection, 5 with a third, and one with a fourth reinfection. The reinfection incidence was 7.3/100 person-years (95% CI 6.2-8.6). We found a trend for lower incidence among individuals who had spontaneously cleared their incident infection than among individuals who were treated (Hazard ratio 0.62, 95% CI 0.38-1.02, p=0.06). Spontaneous clearance of reinfection was associated with ALT levels >1000IU/ml and spontaneous clearance of a prior infection. CONCLUSIONS HCV reinfection is an issue of major concern in HIV-positive MSM. Prevention strategies are needed for high risk groups to reduce morbidity and treatment costs. HIV-positive MSM with a prior HCV infection should be tested every 3 to 6months for reinfection. Those who had achieved a reinfection should be tested every 3months. LAY SUMMARY We evaluated the occurrence of HCV reinfection in HIV-positive men who have sex with men. We found an alarming incidence of 7.3/100 person-years. Prevention measures need to address this specific subgroup of patients at high risk for HCV.
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Affiliation(s)
| | | | | | | | - Stefan Mauss
- Center for HIV and Hepatogastroenterology, Duesseldorf, Germany
| | | | - Mattias Mandorfer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Julie Bottero
- Service des maladies infectieuses et tropicales, Hôpital Saint-Antoine, AP-HP, France
| | | | | | - Karine Lacombe
- Service des maladies infectieuses et tropicales, Hôpital Saint-Antoine, AP-HP, France; Sorbonne Universités, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Mark Nelson
- Chelsea and Westminster Hospital, London, United Kingdom; Imperial College School of Medicine, London, United Kingdom
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Makhluf H, Kim K, Shresta S. Novel strategies for discovering inhibitors of Dengue and Zika fever. Expert Opin Drug Discov 2016; 11:921-3. [DOI: 10.1080/17460441.2016.1212013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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