Interferon-free therapy for treating hepatitis C virus in difficult-to-treat HIV-coinfected patients

Real-World Effectiveness of Direct-Acting Antiviral Regimens against Hepatitis C Virus (HCV) Genotype 3 Infection: A Systematic Review and Meta-Analysis

Patients with hepatitis C virus (HCV) genotype 3 (GT3) infection are resistant to direct-acting antiviral (DAA) treatments. This study aimed to analyze the effectiveness of sofosbuvir (SOF)+daclatasvir (DCV) ± ribavirin (RBV); SOF+velpatasvir (VEL)±RBV; SOF+VEL+voxilaprevir (VOX); and glecaprevir (GLE)+pibrentasvir (PIB) in the treatment of HCV GT3-infected patients in real-world studies. Articles were identified by searching the PubMed, EMBASE, and Cochrane Library databases from January 1, 2016 to September 10, 2019. The meta-analysis was conducted to determine the sustained virologic response (SVR) rate, using R 3.6.2 software. Thirty-four studies, conducted on a total of 7328 patients from 22 countries, met the inclusion criteria. The pooled SVR rate after 12/24 weeks of treatment was 92.07% (95% CI: 90.39-93.61%) for the evaluated regimens. Also, the SVR rate was 91.17% (95% CI: 89.23-92.94%) in patients treated with SOF+DCV±RBV; 95.08% (95% CI: 90.88-98.13%) in patients treated with SOF+VEL±RBV; 84.97% (95% CI: 73.32-93.91%) in patients treated with SOF+VEL+VOX; and 98.54% (95% CI: 96.40-99.82%) in patients treated with GLE+PIB. The pooled SVR rate of the four regimens was 95.24% (95% CI: 93.50-96.75%) in non-cirrhotic patients and 89.39% (95% CI: 86.07-92.33%) in cirrhotic patients. The pooled SVR rate was 94.41% (95% CI: 92.02-96.42%) in treatment-naive patients and 87.98% (95% CI: 84.31-91.25%) in treatment-experienced patients. The SVR rate of GLE+PIB was higher than other regimens. SOF+VEL+VOX can be used as a treatment regimen following DAA treatment failure.

Impact of CD4+ blood cell count and HIV viral load on treatment response with direct acting antivirals in HIV and HCV coinfected patients: insights from the German Hepatitis C-Registry

BACKGROUND

Direct-acting antivirals (DAAs) lead to high cure rates of Hepatitis C Virus (HCV) infections in HIV/HCV coinfected patients. Recent data suggest that treatment failures occur more often in HIV/HCV coinfected persons.

OBJECTIVE

We aimed to identify risk factors for treatment failure in coinfected patients.

METHODS

We analyzed data collected from the German Hepatitis C-Registry (DHC-R, Trials Registration number DRKS00009717). 437 HIV/HCV coinfected patients were included. Sustained virological response (SVR) rates and the impact of CD4+ count, HIV viral load, liver cirrhosis and splenomegaly were evaluated.

RESULTS

83.5% (365/437) of the patients were male (average age: 46.6 ± 9.2 y). Most patients received antiretroviral therapy (ART) (88.1%; 385/437), had a HIV RNA ≤40 copies/ml (88.5%; 285/322) and were infected with HCV genotype (GT) 1 (77.6%; 339/437). Overall SVR12 rate was 92% (402/437). In patients with HIV RNA ≤40 copies/ml and >40 copies/ml SVR12 rates were 93.2% (272/292) and 85.3%, respectively (29/34; p = .11). SVR12 rates were 91.8% (45/49) and 92.7% (253/273; p = .84) in patients with a CD4+ <350/µl and ≥350/µl. We observed no difference in either of the subgroups in patients with cirrhosis or splenomegaly. In the univariate logistic regression analysis none of the analyzed HIV or HCV specific parameters, liver cirrhosis or splenomegaly were associated with treatment outcome.

CONCLUSION

We found high SVR12 rates in HIV/HCV coinfected patients and no significant difference was observed due to the patients CD4+ cell count, HIV viral load, portal hypertension or liver cirrhosis.

Changes of body immunity and inflammatory response in HIV/HCV co-infected patients

Changes of body immunity and inflammatory response in human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infected patients were investigated. Eighty HIV/HCV infected patients admitted to Qingdao No. 6 People's Hospital from August 2015 to December 2017 were selected and divided into two groups according to whether they were complicated with HCV infection or not (n=40 per group). The changes of the related humoral immune indexes, the related cellular immune indexes, the related indexes of hepatic function, the related indexes of inflammatory response in the two groups were compared, and the correlations of high-sensitivity C-reactive protein (hs-CRP) level with alanine aminotransferase (ALT) level, immunoglobulin G (IgG) level and cluster of differentiation 4+ (CD4+) level in the observation group were analyzed. The levels of related humoral immune indexes [immunoglobulin G (IgG), IgA and IgM levels], the related cellular immune indexes (CD4+ and CD8+) in the observation group were lower than those in the control group (P<0.05), and the CD4+/CD8+ ratio in the observation group was lower than that in the control group (P<0.05). The levels of indexes of hepatic function [ALT, aspartate aminotransferase (AST) and total bilirubin] in the observation group were significantly higher than those in the control group (P<0.05). The levels of hs-CRP, interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) in the observation group were significantly higher than those in the control group (P<0.05). There were positive correlations of hs-CRP level with ALT level and IgG level in the observation group (P<0.05). There was a negative correlation between hs-CRP level and CD4+ level in the observation group (P<0.05). The humoral and cellular immune functions of the HIV/HCV co-infected patients are significantly limited, their hepatic function is significantly impaired and the levels of inflammatory cytokines are markedly increased. The level of hs-CRP is positively correlated with hepatic function and humoral immune function and negatively correlated with cellular immune function.