HCV Treatment for HIV-Coinfected Patients — Getting Better All the Time

Helmut Albrecht, MD reviewing Naggie S et al. N Engl J Med 2015 Jul 21. Wyles DL et al. N Engl J Med 2015 Jul 21.

Two open-label studies confirm that a once-daily combination of sofosbuvir plus either ledipasvir or daclatasvir cures hepatitis C virus infection in most such patients.

Due to shared transmission routes, hepatitis C virus (HCV) affects many people living with HIV infection. Despite better HIV treatment options, HCV continues to be a major cause of morbidity and mortality in such individuals. The newer HCV treatment regimens have been proven efficacious and well tolerated in HIV-uninfected patients, but more data are needed regarding coinfected individuals, given the significant drug interactions between antiretrovirals and anti-HCV medications.

Now, in two manufacturer-supported, open-label trials, researchers have examined the efficacy of once-daily combination regimens involving the nucleotide analog inhibitor sofosbuvir plus one of two FDA-approved NS5A inhibitors — ledipasvir (S/L; n=335; 55% treatment-experienced and 20% with compensated cirrhosis) or daclatasvir (S/D; n=203; 25% treatment-experienced and 14% with cirrhosis).

Cure rates (i.e., rates of sustained virologic response at posttreatment week 12) were 96.1% overall for the 12-week S/L regimen, 97.0% for treatment-naive patients with 12 weeks of S/D, 76.0% for treatment-naive patients with 8 weeks of S/D, and 98.1% for treatment-experienced patients with 12 weeks of S/D. Side effects were generally mild, and not a single patient stopped therapy because of adverse events.

Citation(s):

Naggie S et al. Ledipasvir and sofosbuvir for HCV in patients coinfected with HIV-1. N Engl J Med 2015 Jul 21; [e-pub].

Wyles DL et al. Daclatasvir plus sofosbuvir for HCV in patients coinfected with HIV-1. N Engl J Med 2015 Jul 21; [e-pub].