Another analysis, however, reached a different conclusion.
Karin Neukam of Hospital Universitario de Valme in
Seville and colleagues evaluated the impact of HIV co-infection on the efficacy
and safety of DAA treatment, with or without interferon, among patients in a
real-world clinical setting.
This prospective analysis included 680 hepatitis C
mono-infected participants in the GEHEP-MONO cohort and 596 patients
with HIV/HCV co-infection in the HEPAVIR-DAA cohort who received DAA
treatment in outpatient
clinics at 33 hospitals throughout Spain since October 2011. About
were men and the median age was approximately 52 years. The most common
genotypes were 1a and 1b. About 60% had received previous hepatitis C
and a similar proportion had cirrhosis.
Just over 40% received three-drug combinations of pegylated
interferon and weight-based ribavirin along with sofosbuvir, simeprevir,
boceprevir, or telaprevir. The rest (57%) received interferon-free regimens
including sofosbuvir with either simeprevir, ledipasvir, or daclatasvir (Daklinza), or the 3D regimen or a
similar combination without dasabuvir (known as 2D), all with or without
SVR12 rates using interferon-containing therapy were
66% for HCV mono-infected patients, falling to 55% for HIV/HCV co-infected
patients, a significant difference (p = 0.019). Cure rates using interferon-free
DAA regimens were 95% and 89%, respectively, also significantly different (p = 0.002).
In a multivariate analysis adjusted for age, sex, HCV
genotype and baseline HCV viral load, HIV/HCV co-infection was independently
associated with a lower likelihood of sustained response (adjusted odds ratio
[aOR] 0.59), as was liver cirrhosis (aOR 0.60), while use of interferon-free
therapy increased the likelihood of a cure (aOR 7.93). Specific DAA regimen,
treatment duration, use of ribavirin, prior treatment experience and baseline
HCV viral load were not significant predictors of response.
"HIV/HCV co-infected patients seem to respond
worse to DAA-based therapy than HCV mono-infected subjects," the
"The underlying reason for this finding is
unclear," they added. "The poorer immune response against HCV,
adherence issues, or severity of liver damage could theoretically play a
"These differing data confirm that the study of HCV treatment in
HIV co-infected patients remains an interesting and valuable subject for
study," commented EASL secretary general Laurent Castera. "More
research is needed to come to a viable resolution so we can provide the best
care for these co-infected patients."