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Unsuccessful Direct Acting Antiviral Hepatitis C Treatment Among People With HIV: Findings From an International
Brendan L Harney1,2,3, Rachel Sacks-Davis1,2,4, Daniela K van Santen1,5
1Disease Elimination Program, Burnet Institute, Melbourne, Australia.
Insights
Direct-acting antivirals (DAAs) cure most hepatitis C virus (HCV) infections in people with HIV. However, lower CD4+ counts and recent injection drug use are linked to unsuccessful HCV treatment outcomes.
Area of Science:
- Hepatology
- Infectious Diseases
- HIV Medicine
Background:
- Hepatitis C virus (HCV) historically posed treatment challenges for individuals with HIV.
- Direct-acting antivirals (DAAs) have significantly improved cure rates, achieving 90%-95% success.
- Understanding factors contributing to treatment failure is crucial for optimizing HCV elimination strategies in this population.
Purpose of the Study:
- To identify characteristics associated with unsuccessful direct-acting antiviral (DAA) treatment for hepatitis C virus (HCV) in people living with HIV.
- To investigate predictors of sustained virologic response (SVR) in this cohort.
Main Methods:
- Utilized data from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (2014-2019).
- Included individuals commencing DAA HCV treatment.
- Employed multivariable mixed-effects logistic regression to analyze factors associated with unsuccessful treatment, defined as detectable HCV RNA at least 4 weeks post-treatment (SVR4+).
Main Results:
- Of 4468 participants, 91.7% had an SVR4+ test, with 5% experiencing treatment failure.
- Lower CD4+ cell counts (<200 cells/mm³ or 200-349 cells/mm³) were associated with increased odds of unsuccessful treatment compared to counts >500 cells/mm³.
- Recent injection drug use showed a non-significant trend towards increased odds of unsuccessful treatment (aOR 1.67, 95%CI 0.99-2.82).
Conclusions:
- DAA treatment is highly effective for the vast majority of people with HIV and HCV.
- Immunodeficiency (indicated by lower CD4+ counts) and recent injection drug use emerged as key factors associated with higher rates of unsuccessful HCV treatment.
- Further research may be warranted to explore the impact of recent injection drug use on DAA treatment outcomes.
Background:
Historically, hepatitis C virus (HCV) was difficult to treat among people with HIV. However, treatment with direct-acting antivirals (DAAs) results in 90%-95% of people being cured. There is a need to understand why a proportion of people are not cured. We aimed to examine characteristics that may indicate an increased probability of unsuccessful DAA HCV treatment.
Methods:
Data were from the International Collaboration on Hepatitis C Elimination in HIV Cohorts. People who commenced DAA HCV treatment between 2014 and 2019 were included. Unsuccessful treatment was defined as a positive HCV RNA test at a person's first RNA test at least 4 weeks (SVR4+) following the end of treatment. Multivariable mixed-effects logistic regression was used to examine characteristics associated with unsuccessful treatment.
Results:
Of 4468 people who commenced DAA treatment, 4098 (91.7%) had an SVR test 4+ weeks following the end of treatment, 207 (5%) of whom were unsuccessfully treated. Compared to a CD4+ cell count > 500 cells/mm3, cell counts < 200 (aOR 1.81, 95%CI 1.00-3.29) and between 200 and 349 (aOR 1.95, 95%CI 1.30-2.93) were associated with increased odds of unsuccessful treatment. Among 1921 people with data on injection drug use in the 12 months prior to treatment, there was some evidence that recent injection drug use was associated with increased odds of unsuccessful treatment; however, this was not statistically significant (aOR 1.67, 95%CI 0.99-2.82).
Conclusions:
The overwhelming majority of people were successfully treated for HCV. Overall, 5% of those with an SVR4+ test were unsuccessfully treated; this was more likely among people with evidence of immunodeficiency and those who reported recently injecting drugs.
