HCV Treatment Outcomes in HIV-HCV Co-infected Patients at an Urban, Academic, Health System.

Background: The approval and introduction of direct-acting antivirals (DAAs) created a major paradigm shift in the treatment of chronic hepatitis C.  Currently, there is little “real world” data of HCV treatment outcomes in the HIV-HCV co-infected population.

Methods:  This retrospective cohort study examined HCV treatment outcomes of HIV-HCV co-infected patients treated at an urban, academic, health system serving an underserved population.  All HIV patients initiating HCV treatment from January 1, 2013 to December 31, 2015 were included in the analysis.   The primary end point was SVR12.  The lower limit of quantification was 12 IU/ml.   

Results: A total of 205 patients were initiated on HCV treatment within the specified time period, of which 79% were male, 82% were black, 79% were treatment naïve, and 17% had cirrhosis.  At baseline, 94% were HCV genotype 1 (49% 1a, 21% 1b), median CD4 was 493 cells/µL (IQR 316, 722) and 92% had HIV RNA less than 40 copies/ml. The most common medication initiated was sofosbuvir/ledipasvir (SOF/LDV) (80%), with 88% receiving 12 weeks of treatment.  Overall response rates were as follows:  69% achieved a rapid virologic response (RVR), 98% achieved an end-of-treatment response (ETR), and 95% achieved sustained virologic response at 12 weeks (SVR12).  SVR12 were similar regardless of cirrhosis or treatment experience. Among the 9 patients not achieving SVR12, reasons include the following:  2 treatment failures on SOF/LDV, 4 discontinuations due to adverse effects (3 on telaprevir/peg-interferon/ribavirin and 1 on sofosbuvir/ribavirin), 2 discontinuations due to incarceration, and 1 lost to follow-up.  None of the patients on SOF/LDV discontinued treatment due to adverse events, with the majority of patients (70%) not experiencing any adverse effect.

Conclusion:  In a cohort of mainly black, male, HIV co-infected patients at an urban, academic, health system, HCV treatment with DAAs was well tolerated.  The majority of patients completed therapy and cure rates were high.

Table 1:  Response to Treatment 

Response	Overall (n=205)	No Cirrhosis (n=170)	Cirrhosis (n=35)	Treatment Naïve (n=162)	Treatment Experienced (n=43)	Genotype 1 (n=193)	Treatment with SOF/LDV (n=165)
RVR	69%	71%	27%	64%	58%	63%	62%
ETR	98%	98%	100%	98%	100%	98%	98%
SVR12	95%	93%	100%	95%	94%	95%	96%