DI-062 New direct acting antiviral based therapies in hiv/hcv coinfected patients: management and effectiveness in a study population

BackgroundTreatment of HIV/HCV coinfected patients requires attention to the complex drug interactions that can occur between new direct acting antivirals (DAAs) and antiretroviral drugs (ARVs).PurposeTo assess the effectiveness of new DAAs in a HIV-HCV coinfected population, and tTo review ARVs switches to allow compatibility of DAAs.Material and methodsThis was an observational retrospective study. HIV/HCV coinfected patients treated with ledipasvir/sofosbuvir (LDV/SOF), ritonavir boosted paritaprevir/ombitasvir, dasabuvir (3D) or daclatasvir+sofosbuvir (DCV+SOF) were included from 1 April 2015 to 30 June 2016. Effectiveness was measured as rate of sustained viral response at 12 weeks after the end of therapy (SVR12). Collected data: age, gender, genotype, grade of fibrosis (METAVIR score), presence of cirrhosis, HCV RNA baseline and HCV treatment history.ResultsA total of 71 subjects were studied, 79% (n=56) were men. Median age was 50 years (34–64). HCV genotypes (GT): GT1a (n=35), GT1b (n=16), GT3 (n=12) and GT4 (n=8). DAAs: 53 patients were treated with LDV/SOF (±RBV), 10 with DCV+SOF (±RBV) and 8 with 3D (±RBV). Fibrosis stage was F3–F4 in 58 (82%) patients and 43 (66%) had cirrhosis. Ribavirin was used in combination with DAAs in 32% of subjects; 51% (n=36) were naive, 48% had been previously treated with interferon+RBV and 1 patient with triple therapy. Mean HCV RNA baseline was 2.505.210 UI/mL. Overall, 66 patients (93%) achieved SVR12: including rates of 90% (GT1), 100% (GT3) and 100% (GT4). 5 patients did not achieve SVR12: adverse event (n=1), death (n=2) and relapse (n=2). In 9 (13%) patients at least one antiretroviral drug was switched and in all cases to an integrase inhibitor based regimen. Some interactions were found: tenofovir (with ritonavir boosted or efavirenz containing regimen) when given LDV/SOF (n=5), ritonavir boosted protease inhibitors with 3D or DCV (n=3) and etravirine with DCV (n=1). In 1 patient, the daily dose of DCV was reduced to half (30 mg/day).ConclusionEffectiveness outcomes in the clinical setting were similar to clinical trials. New DAAs require few changes in antiretroviral therapy. LDV/SOF may be used with most ARVs, but renal function monitoring is required with tenofovir. The inhibitors of integrase might be a therapeutic of choice for the HIV/HCV coinfected population.No conflict of interest