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Current guidelines and prioritizing treatment of hepatitis C virus in HIV-infected patients

Eoin R Feeney1, Raymond T Chung, Yazdan Yazdanpanah

  • 1aHIV Molecular Research Group, University College Dublin, Dublin, Ireland bDivision of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA cService de maladies Infectieuses et tropicales, Hôpital Bichat Claude Bernard dInserm UMR 1137, IAME eUniv Paris Diderot, Sorbonne Paris Cité, Paris, France.

Current Opinion in HIV and AIDS
|August 7, 2015
PubMed

Insights

Direct-acting antivirals (DAA) offer a high cure rate for hepatitis C virus (HCV) in patients with HIV coinfection. Guidelines prioritize these coinfected individuals for treatment, though cost remains a barrier.

Area of Science:

  • Hepatology
  • Virology
  • Infectious Diseases

Background:

  • Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) coinfection presents a global health challenge.
  • Traditional interferon-alpha (IFN) and ribavirin (RBV) treatments yield lower efficacy and higher toxicity in coinfected patients compared to HCV monoinfection.
  • Direct-acting antivirals (DAA) have revolutionized HCV treatment, offering improved tolerability and cure rates.

Purpose of the Study:

  • To review the efficacy and cost-effectiveness of DAA-based regimens in HIV-HCV coinfection.
  • To assess the impact of DAA on treatment outcomes for coinfected individuals.
  • To inform treatment guidelines and prioritization for HCV in the context of HIV coinfection.

Main Methods:

  • Review of current literature on DAA efficacy in HIV-HCV coinfection.
  • Analysis of cure rates, tolerability, and cost-effectiveness data.
  • Examination of recent treatment guidelines and recommendations.

Main Results:

  • DAA regimens demonstrate high efficacy (over 90% cure rate goal) in HIV-HCV coinfection, comparable to HCV monoinfection.
  • Excellent data exists for genotype 1, with ongoing research for genotypes 2-6.
  • DAA regimens are likely cost-effective, but high costs may limit widespread access, particularly in the short term.

Conclusions:

  • HCV infection is now curable in most HIV-infected patients using DAA.
  • HIV-HCV coinfected patients are prioritized for DAA treatment, irrespective of liver fibrosis stage.
  • Optimal DAA regimens for certain genotypes and managing cost-related access barriers require further determination.
Abstract

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