Daclatasvir plus Sofosbuvir,with or without Ribavirin,in Real-World Patients with HIV–HCV Coinfection and Advanced Liver Disease

Abstract

Background

HIV–HCV-coinfected patients respond just as well to modern direct-acting antiviral HCV therapy as HCV-monoinfected patients. However, clinical data for all-oral HCV treatments are sparse in HIV–HCV-coinfected patients with an advanced stage of liver cirrhosis.

Methods

A subanalysis of efficacy and safety for a daclatasvir (DCV) and sofosbuvir (SOF) regimen, with or without ribavirin (RBV), was undertaken in HIV–HCV-coinfected patients with advanced liver disease and no other treatment options enrolled into a European DCV compassionate use programme.

Results

Fifty five HIV–HCV (mostly genotypes 1, 3, 4) coinfected patients were treated with DCV+SOF with (n=16) or without RBV (n=39), mostly for 24 weeks. Patients were predominantly (95%) cirrhotic (50% were Child–Pugh class B or C) and were receiving a wide range of antiretrovirals; 40% were injection drug users and 25% were receiving oral opioid substitution. Sustained virological response at post-treatment week 12 (SVR12) by modified intention-to-treat analysis (n=52) was 92% overall (95% CI 81.5, 97.9), and was similar with (94% [95% CI 69.8, 99.8]) or without RBV (92% [95% CI 77.5, 98.2]). Only one patient relapsed (Child–Pugh class B). The overall SVR12 rate after excluding non-virologi-cal failures (n=49) was 98% (95% CI 89.1, 99.9). Four patients discontinued treatment for adverse events and one died during treatment (not treatment-related). No patient lost opioid maintenance or required a change of antiretrovirals due to drug–drug interactions.

Conclusions

DCV+SOF, with or without RBV, showed high SVR12 rates and was well tolerated in this real-world cohort of HIV–HCV-coinfected patients with very advanced liver disease. ClinicalTrials.gov ID NCT02097966 (Study AI444-237).

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