Reported adverse events related to use of hepatitis C virus direct-acting antivirals with opioids: 2017-2021

INTRODUCTION

Due to concerns over potential interactions between some hepatitis C direct-acting antivirals (DAAs) and opioids, we describe adverse event (AE) reports of concomitant use of opioids and DAAs.

METHODS

AEs reported (July 28, 2017-December 31, 2021) with the administration of the DAAs glecaprevir/pibrentasvir, sofosbuvir/velpatasvir, ledipasvir/sofosbuvir, sofosbuvir/velpatasvir/voxilaprevir, and elbasvir/grazoprevir as suspect products were downloaded from the US Food and Drug Administration AE Reporting System Public Dashboard. The number of AE reports containing opioids (fentanyl, hydrocodone, oxycodone) as co-suspect products/concomitant products were counted and summarized by severity, reporting country and whether an outcome of death was reported. Overdose AEs were counted irrespective of opioid use, and changes over time were assessed.

RESULTS

In total, 40 AEs were reported for DAAs and concomitant fentanyl use, 25 (62.5%) were in the USA, 35 (87.5%) were considered serious, and 14 (35.0%) resulted in death; and 626 were reported with concomitant oxycodone/hydrocodone use, 596 (95.2%) were in the USA, 296 (47.3%) were considered serious, and 28 (4.5%) resulted in death. There were 196 overdose AEs (32 [16%] deaths) declining from 2018 (N = 56) to 2021 (N = 29).

CONCLUSIONS

Treating people with hepatitis C virus (HCV) infection who use drugs is key to achieving HCV elimination. Low numbers of DAA AE reports with opioids may provide reassurance to prioritize HCV treatment in this population. These data contribute to evidence supporting the continued scale-up of DAA treatment among people who use drugs to achieve HCV elimination goals.

Safety and efficacy of lopinavir/ritonavir-containing antiretroviral therapy in patients aged <50 versus ≥50 years from randomized trials

ABSTRACT: 

Aim: Data describing the safety and efficacy of antiretroviral therapy (ART) in HIV-infected patients aged ≥50 years are limited. We evaluated the effect of age on safety, efficacy and tolerability in patients aged <50 and ≥50 years receiving lopinavir/ritonavir (LPV/r)-containing ART. Methods: End points from AbbVie Inc. (IL, USA) or AIDS Clinical Trials Group randomized clinical trials in adults using LPV/r 800/200 mg/day as part of a three-drug regimen (follow-up ≥48 weeks) were evaluated using a random-effects meta-analysis (virologic efficacy; intent-to-treat; noncompleter = failure) or pooled data (other end points). Results: A total of 2608 patients (2294.3 patient-years of follow-up) from ten trials were included: 2248 patients (86.2%) <50 years of age and 360 (13.8%) ≥50 years of age. Demographics and baseline characteristics were similar between age groups. At week 48, 64.9 and 67.8% of patients <50 and ≥50 years, respectively, had plasma HIV-1 RNA <50 copies/ml (random effects meta-analysis p = 0.992). Mean change from baseline in CD4+ T-cell count was +193.9 and +163.5 cells/μl (<50 and ≥50 years, respectively; p < 0.001). Smaller proportions of patients <50 years of age discontinued due to adverse events (AEs)/HIV-related events (4.9 vs 9.4%; p = 0.001) and reported moderate-to-severe treatment-related AEs (30.5 vs 36.4%; p = 0.027) compared with patients ≥50 years of age. Conclusion: This analysis suggests LPV/r-anchored three-drug therapy in patients ≥50 years of age leads to comparable rates of virologic suppression, with a smaller increase in absolute CD4+ T cells and increased AEs, including discontinuations associated with AEs compared with patients <50 years of age.

A rapid and simple method for extracting human immunodeficiency virus type 1 RNA from plasma: enhanced sensitivity

We present here a rapid and simple technique for processing human immunodeficiency virus (HIV)-infected plasma by high-speed centrifugation. HIV type 1 virions are pelleted from up to 1 ml of plasma, gently lysed with a nonionic detergent, and directly amplified. The procedure has few manipulations and requires approximately 1.5 h for the processing of 24 samples. Viral recovery ranges from 80 to 90%, with an analytical sensitivity approaching 20 copies/ml.