2150. HCV Treatment Failure in HIV Co-Infected Patient
Session: Poster Abstract Session: HIV/HCV Coinfection and Liver Disease
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • IDSA 2016 poster HCV-HIV (Read-Only).pdf (383.0 kB)
  • Background: The treatment of HIV/ HCV co-infection presents many treatment challenges as newer combination therapies are used. We present a case of Hepatitis C treatment failure in an HIV-coinfected patient which resulted in NS5A, NS5B, and NS3/4A pan-resistance.

    Methods: A 62-year old AA male diagnosed with HIV in 2010 was subsequently treated and achieved complete virologic suppression for 5 years and CD4 >300. He was co-infected with HCV C Genotype 1a, pretreatment HCV RNA 7.6 log (44,000,000 copies/ml) and baseline HCV RNA of 6.9 log (8,300,000 copies/ml). Liver biopsy showed minimal chronic hepatitis with no significant fibrosis (histologic stage and grade: Grade 1/4, Stage 0/4) with a Prometheus® FIBROSpect Index score of 38, consistent with a Metavir score of F0-F1. Ten days prior to the start of ombitasvir/paritaprevir/ritonavir/ dasabuvir (PrOD) and weight-based ribavirin(RBV), his HIV regimen was switched to dolutegravir and emtricitabine/tenofovir disoproxil fumarate(FTC/TDF). Concurrent medications were daily HCTZ and monthly IM testosterone.

    Results: Serial HCV RNA are provided in Table 1. HCV treatment was discontinued at week 10. Testing for HCV resistance associated variants (RAV) was performed (Table 2). The patient stated complete adherence to treatments. He had received home nursing visits, extensive counseling and review of all medications for drug-drug interactions, yet failed to achieve an undetectable HCV RNA. Stored serum samples from the prior 24 months were sent to identify presence of RAVs and showed pre-treatment resistance (Table 2).

    Table 1

    Week

    HCV RNA (log;copies/ml)

    0

    6.9 log; 8,300,000

    4

    5.4 log; 230,000

    7

    5.0 log; 110,000

    10

    5.2 log; 150,000

    Table 2

    Generic

    Region

    Pre-Treatment RAV Detected

    Pre-Treatment Interpretation

    Post-Treatment RAV Detected

    Post-Treatment Interpretation

    Dasabuvir

    NS5B

    None

    None/UD

    C316C/Y

    R

    Ombitasvir

    NS5A

    Y93H

    RP

    Y93H

    R

    Paritaprevir

    NS3

    Q80K

    None/UD

    F43L, Q80K, I132L/V, D168E

    R

    R Resistance; RP Resistance Possible; UD Undetermined

    Conclusion:

    Baseline testing for HCV RAVs before HCV treatment should be considered in HIV co-infected patients to avoid development of pan-resistance with selection of additional RAVs. With the significant cost currently associated with HCV treatment, baseline HCV resistance testing may also prove to be cost-effective.

    Joan Duggan, MD, FIDSA, FACP, Department of Medicine, Division of Infectious Diseases, University of Toledo College of Medicine, Toledo, OH and Eric Sahloff, PharmD, AAHIVP, Pharmacy Practice, University of Toledo, Toledo, OH

    Disclosures:

    J. Duggan, None

    E. Sahloff, None

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