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Macías J, Téllez F, Rivero-Juárez A, Palacios R, Morano LE, Merino D, Collado A, García-Fraile L, Omar M, Pineda JA. Early emergence of opportunistic infections after starting direct-acting antiviral drugs in HIV/HCV-coinfected patients. J Viral Hepat 2019; 26:48-54. [PMID: 30199593 DOI: 10.1111/jvh.13003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/19/2018] [Accepted: 08/15/2018] [Indexed: 12/14/2022]
Abstract
Varicella-zoster virus and hepatitis B virus reactivations have been reported after starting interferon-free direct-acting antiviral agent (DAA) combinations. HIV/HCV-coinfected patients could be a high-risk group for the reactivation of latent infections. Because of these, we report the occurrence of severe infections after starting DAA regimens in HIV/HCV-coinfected patients. Individuals included in the HEPAVIR-DAA (NCT02057003) cohort were selected if they had received all-oral DAA combinations. A retrospective review of clinical events registered between the start of DAAs and 12 months after SVR12 was carried out. Overall, 38 (4.5%) of 848 patients presented infections. The incidence (95% confidence interval) of infections was 4.6 (3.3-6.3) cases per 100 person-years. The median (Q1-Q3) time to the infection since baseline was 23 (7.3-33) weeks. Five (13%) of the patients with infections died; four of them had cirrhosis. The frequency of previous AIDS was 21 (54%) for patients with infections and 324 (40%) for those without infections (P = 0.084). The median (Q1-Q3) nadir CD4 cell count of individuals with and without infections was 75 (53-178) and 144 (67-255) cells/μL, respectively (P = 0.047). Immunodepression-associated infections were observed in 9 (1.1%) patients. All of them had suppressed HIV replication with antiretroviral therapy. In conclusion, severe infections are relatively common among HIV/HCV-coinfected patients receiving all-oral DAA combinations. Some unusual reactivations of latent infections in patients with suppressed HIV replication seem to be temporally linked with DAA use.
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Affiliation(s)
- Juan Macías
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain
| | - Francisco Téllez
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Puerto Real, Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cadiz, Spain
| | - Antonio Rivero-Juárez
- Instituto Maimonides de Investigación Biomedica de Córdoba (IMIBIC), Hospital Universitario Reina Sofia, Cordoba, Spain
| | - Rosario Palacios
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Luis E Morano
- Infectious Diseases Unit, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - Dolores Merino
- Infectious Diseases Unit, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Antonio Collado
- Infectious Diseases Unit, Hospital Torrecárdenas, Almeria, Spain
| | - Lucio García-Fraile
- Infectious Diseases-Internal Medicine Service, Hospital Universitario de la Princesa, Madrid, Spain
| | - Mohamed Omar
- Infectious Diseases Unit, Hospital de Jaen, Jaen, Spain
| | - Juan A Pineda
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain
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