The recent availability of new direct-acting antivirals (DAAs) for HCV treatment, which significantly increase sustained virological response rates for genotype 1 HCV infection, has brought new optimism with respect to curative HCV treatment for HIV–HCV-coinfected patients. We describe the characteristics of coinfected patients who could be eligible for DAAs to determine potential challenges facing clinicians and patients hoping to take advantage of these new therapies.
Methods
We evaluated the sociodemographic and clinical characteristics of the genotype 1 HCV–HIV-infected participants in a Canadian prospective multicentre cohort study at their most recent visit to assess potential eligibility for combination HCV treatment with boceprevir or telaprevir.
Results
Of the 1,020 coinfected participants enrolled in the cohort, 707 (85%) had evidence of chronic HCV infection (HCV-RNA-positive), of whom 497 (70%) were infected with genotype 1; 375 (75%) were naive to HCV treatment and 122 (25%) had previously received therapy and failed. Only 143 (38%) of HCV treatment-naive and 39 (32%) of treatment-experienced participants had no absolute contraindications for treatment. Alcohol abuse, active depression and decompensated liver disease were the most frequent reasons for treatment ineligibility. The majority would require alterations in antiretroviral regimens to avoid important drug–drug interactions.
Conclusions
Although the need for curative HCV therapy in HIV–HCV coinfection is great, the actual number of patients who could be eligible for DAAs at the present time may be quite low. There remains an urgent need to develop safe, simple and interferon-sparing treatments for coinfected individuals.
References
1.
GrahamC.S., BadenL.R., YuE.Influence of human immunodeficiency virus infection on the course of hepatitis C virus infection: a meta-analysis. Clin Infect Dis2001; 33: 562–569.
2.
MacíasJ., BerenguerJ., JaponM.A.Fast fibrosis progression between repeated liver biopsies in patients coinfected with human immunodeficiency virus/hepatitis C virus. Hepatology2009; 50: 1056–1063.
3.
BerenguerJ., Alvarez-PellicerJ., MartinP.M.Sustained virological response to interferon plus ribavirin reduces liver-related complications and mortality in patients coinfected with human immunodeficiency virus and hepatitis C virus. Hepatology2009; 50: 407–413.
4.
TorrianiF.J., Rodriguez-TorresM., RockstrohJ.K.Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection in HIV-infected patients. N Engl J Med2004; 351: 438–450.
5.
ChungR.T., AndersenJ., VolberdingP.Peginterferon alfa-2a plus ribavirin versus interferon alfa-2a plus ribavirin for chronic hepatitis C in HIV-coinfected persons. N Engl J Med2004; 351: 451–459.
6.
CarratF., Bani-SadrF., PolS.Pegylated interferon alfa-2b vs standard interferon alfa-2b, plus ribavirin, for chronic hepatitis C in HIV-infected patients: a randomized controlled trial. JAMA2004; 292: 2839–2848.
7.
LagunoM., MurillasJ., BlancoJ.L.Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for treatment of HIV/HCV co-infected patients. AIDS2004; 18: F27–F36.
8.
ButtA.A., KanwalF.Boceprevir and telaprevir in the management of hepatitis C virus-infected patients. Clin Infect Dis2012; 54: 96–104.
9.
SulkowskiM., PolS., CooperC.Boceprevir + pegylated interferon + ribavirin for the treatment of HCV/HIV-coinfected patients: end of treatment (week-48) interim results.19th Conference on Retroviruses and Opportunistic Infections. 5–8 March 2012, Seattle, WA, USA. Abstract 47.
10.
DieterichD., SorianoV., ShermanK.Telaprevir in combination with pegylated interferon-alfa-2a+RBV in HCV/HIV-co-infected patients: a 24-week treatment interim analysis.19th Conference on Retroviruses and Opportunistic Infections. 5–8 March 2012, Seattle, WA, USA. Abstract 46.
11.
KleinM.B., SaeedS., YangH.Cohort profile: the Canadian HIV-hepatitis C co-infection cohort study. Int J Epidemiol2010; 39: 1162–1169.
12.
BushK., KivlahanD.R., McDonellM.B., FihnS.D., BradleyK.A.The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med1998; 158: 1789–1795.
McHutchisonJ.G., MannsM., PatelK.Adherence to combination therapy enhances sustained response in genotype-1-infected patients with chronic hepatitis C. Gastroenterology2002; 123: 1061–1069.
16.
WeissJ.J., AlcornM.C., RabkinJ.G., DieterichD.T.The critical role of medication adherence in the success of boceprevir and telaprevir in clinical practice. J Hepatol2012; 56: 503–504.
17.
SedenK., BackD.Directly acting antivirals for hepatitis C and antiretrovirals: potential for drug-drug interactions. Current opinion in HIV and AIDS2011, 6: 514–526.
18.
HulskotteE., FengH-P, XuanF.Pharmacokinetic interaction between the HCV protease inhibitor boceprevir and ritonavir-boosted HIV-1 protease inhibitors atazanavir, lopinavir, and darunavir.19th Conference on Retroviruses and Opportunistic Infections. 5–8 March 2012, Seattle, WA, USA. Abstract 77LB.
19.
US Food and Drug Administration.FDA drug safety communication: updated information on drug interactions between Victrelis (boceprevir) and certain boosted HIV protease inhibitor drugs. (Updated 26 April 2012. Accessed 2 June 2012.) Available from http://www.fda.gov/Drugs/DrugSafety/ucm301616.htm.
20.
EronJ.J., YoungB., CooperD.A.Switch to a raltegravir-based regimen versus continuation of a lopinavir-ritonavir-based regimen in stable HIV-infected patients with suppressed viraemia (SWITCHMRK 1 and 2): two multicentre, double-blind, randomised controlled trials. Lancet2010; 375: 396–407.
