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Improving HCV cure rates in HIV-coinfected patients - a real-world perspective
Seetha Lakshmi, Maria Alcaide, Ana M Palacio
1Jackson Medical Towers, Ste 1101, Miami, FL.
Insights
Hepatitis C virus (HCV) cure rates in patients coinfected with human immunodeficiency virus (HIV) were lower than expected but improved with regular clinic visits and integrase-based HIV regimens. Attendance at follow-up visits significantly predicted successful HCV treatment outcomes.
Area of Science:
- Infectious Diseases
- Hepatology
- Virology
Background:
- Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) coinfection presents unique challenges in treatment and management.
- Direct-acting antivirals (DAAs) have revolutionized HCV treatment, but real-world effectiveness in coinfected populations requires further study.
- Understanding predictors of HCV cure is crucial for optimizing treatment strategies in this vulnerable patient group.
Purpose of the Study:
- To determine the rates and predictors of HCV cure in patients coinfected with HIV.
- To evaluate the impact of clinic visit attendance on achieving HCV cure.
- To identify factors associated with successful direct-acting antiviral treatment outcomes.
Main Methods:
- Retrospective cohort study design.
- Inclusion of adult patients coinfected with HIV and HCV who completed DAA treatment.
- Analysis of treatment completion, cure rates, and associated clinical factors, including clinic attendance and HIV antiretroviral regimens.
Main Results:
- An overall HCV cure rate of 83.3% was observed among 84 participants who completed DAA treatment.
- Attendance at follow-up clinic visits was a significant predictor of HCV cure (OR, 9.0).
- Use of an integrase-based HIV regimen was also associated with a higher likelihood of HCV cure (OR, 6.22).
Conclusions:
- Real-world HCV cure rates with DAAs in coinfected patients are lower than clinical trial data suggest.
- Clinic visit attendance and specific HIV antiretroviral regimens are key factors influencing HCV treatment success.
- Further research is needed to optimize HIV/HCV care models, focusing on adherence, monitoring, and antiretroviral selection.
Objectives:
To study rates and predictors of hepatitis C virus (HCV) cure among human immunodeficiency virus (HIV)/HCV-coinfected patients, and then to evaluate the effect of attendance at clinic visits on HCV cure.
Methods:
Retrospective cohort study of adult HIV/HCV-coinfected patients who initiated and completed treatment for HCV with direct-acting antivirals (DAAs) between January 1, 2014, and June 30, 2015.
Results:
Eighty-four participants reported completing treatment. The median age was 58 years (interquartile ratio, 50-66); 88% were male and 50% were black. One-third were cirrhotic and half were HCV-treatment-experienced. The most commonly used regimen was sofosbuvir/ledipasvir (40%) followed by simeprevir/sofosbuvir (30%). Cure was achieved in 83.3%, 11.9% relapsed, and 2.3% experienced virological breakthrough. Two patients (2.3%) did not complete treatment based on pill counts and follow-up visit documentation. In multivariable analysis, cure was associated with attendance at follow-up clinic visits (odds ratio [OR], 9.0; 95% CI, 2.91-163) and with use of an integrase-based HIV regimen versus other non-integrase regimens, such as non-nucleoside analogues or protease inhibitors (OR, 6.22; 95% CI 1.81-141). Age, race, genotype, presence of cirrhosis, prior HCV treatment, HCV regimen, and pre-treatment CD4 counts were not associated with cure.
Conclusions:
Real-world HCV cure rates with DAAs in HCV/HIV coinfection are lower than those seen in clinical trials. Cure is associated with attendance at follow-up clinic visits and with use of an integrase-based HIV regimen. Future studies should evaluate best antiretroviral regimens, predictors of attendance at follow-up visits, impact of different monitoring protocols on medication adherence, and interventions to ensure adequate models of HIV/HCV care.
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