Use of Daclatasvir in HCV/HIV-Coinfected Patients in a Real-Life Setting

The burden of HIV and HCV coinfection is estimated to affect 5-7 million people worldwide, with approximately 15-30% of people with HIV coinfected with HCV. The first oral direct-acting antivirals have shown to improve the response in patients with HIV/HCV coinfection, and more recently, other direct-acting antivirals that target various stages of the HCV life cycle have been developed, among them daclatasvir. The objective of this article is to examine recent clinical studies investigating the efficacy and safety of daclatasvir in comparison with other antiretroviral drugs, focusing on its efficacy in the coinfected HIV patient and real-life data. Daclatasvir is a direct-acting antiviral first-in-class HCV NS5A replication complex inhibitor, approved in June 2014 by the European Medicines Agency for use in combination with other medicinal products for the treatment of chronic HCV infection in adults, and in July 2015 by the Food and Drug Administration. Its efficacy was demonstrated in several trials, with a mean sustained virologic response 12 weeks after therapy completion above 90%. The majority of adverse events related to treatment were mild-to-moderate in severity, with no discontinuation of therapy because of an adverse event and no clinically significant interactions with most of HIV antiretrovirals. The efficacy of daclatasvir in HIV/HCV-coinfected patients was demonstrated in many studies, and confirmed by real-life data for patients with different genotypes, patients with cirrhosis, and in association with ribavirin, opening a new frontier in the treatment of these patients.