Predictive factors of hepatitis C virus eradication after interferon-free therapy in HIV coinfection
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Real-life cohorts have shown that the effectiveness of all-oral, direct-acting antivirals (DAA) for HCV treatment is > 90%. We aimed to explore the predictive factors of DAA success in HIV coinfection. This is an observational prospective study within the cohort “VIH-DOC”, Madrid, Spain. HIV/HCV-coinfected patients were included if they had been treated with DAAs between 9 January 2015 and 31 August 2016. The sustained virological response (SVR) was analysed in the intention-to-treat population. Binary logistic regression was used to study the impact of cirrhosis, anti-HCV therapy experience and the IL28B polymorphism on SVR, besides factors with a p value < 0.15 from the univariate analysis. DAA were prescribed to 423 patients. SVR was confirmed in 92.9%. The univariate analysis showed higher proportion of patients with SVR among those with DAA adherence ≥ 95% (difference + 10.3%, 95% CI 3.5–19.6) and a baseline CD4+ cell count ≥ 200/μL (difference + 14.7%, 95% CI 4.1–31.0). Logistic regression evinced that both DAA adherence and baseline CD4+ cell counts predicted the SVR (OR 3.9, 95% CI 1.8–8.8, and OR 5.2, 95% CI 1.9–13.9, respectively). Moreover, men who reported having sex with other men (MSM) were less likely to achieve SVR (OR 4.2, 95% CI 1.1–16.1). Among MSM, three of three patients without SVR were suspected to have experienced HCV reinfection. DAA for HCV in HIV-coinfected patients is highly effective. DAA adherence ≥ 95% and a baseline CD4+ count ≥ 200/μL predicted a higher probability of SVR. A lower rate of SVR was found in MSM, presumably due to a higher frequency of HCV reinfection.
KeywordsHIV/HCV coinfection Direct-acting antivirals Sustained virological response Treatment adherence HCV reinfection
We thank our trained nurses (Adelina Barrio, Mercedes Morales, Laura Bermejo and Mireia Santacreu) for helping us with the clinical follow-up of the patients.
This work has no funding sources. This study was conducted as part of our routine work. All payments and honoraria reported by each author within her/his conflict of interest statement were received for activities outside the submitted work.
Compliance with ethical standards
Conflict of interest
- LDD has received payment for lectures from Abbvie, Gilead and Janssen, and she has received financial support for expert courses and congress by Merck Sharp and Dome, Gilead and Abbvie.
- OB has received payments for lectures from AbbVie, Merck Sharp and Dome and Janssen, and she has received scholarship for expert courses and congress by Merck Sharp and Dome, Janssen, Bristol-Myers-Squibb, Gilead and Abbvie. Her work is currently supported by the Spanish AIDS Research Network (RD16/0025/0017) that is included in the Spanish I+D+I Plan and is cofinanced by ISCIII-Subdirección General de Evaluación and European Funding for Regional Development (FEDER).
- MM reports honoraria for advisory boards from Abbvie and has received payment for lectures from AbbVie, Bristol-Myers-Squibb and Merck Sharp and Dome.
- ML reports honoraria as speaker in educational programs sponsored by Janssen, ViiV, Gilead, Bristol-Myers-Squibb, Merck Sharp and Dome and Abbvie; has received scholarship for expert courses by Merck Sharp and Dome, Janssen and Abbvie; and has received financial support for national and international HIV courses (registration and travel assistance).
- AH, OP and CL have no conflict of interest.
- RR reports grants and payment for lectures from Abbott, Boehringer Ingelheim, Bristol-Myers-Squibb, Gilead, Janssen, Merck Sharp and Dome and ViiV.
- FP has received honoraria for lectures and advisory boards from Abbvie, Gilead, Janssen and ViiV.
Ethical approval and informed consent
Patients signed an informed consent approved by the Ethics Committee belonging to the Biomedical Research Institute Imas12 (University Hospital 12 de Octubre) when included in the VIH-DOC cohort. This document allows clinical data recollection and analysis for observational study purposes.
Data were anonymised and managed according to the Good Clinical Practice Guidelines published by the World Medical Association Declaration of Helsinki.
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