HIV coinfected have similar SVR rates as HCV monoinfected with DAAs: it’s time to end segregation and integrate HIV patients into HCV Trials.
Shafran SD.
Clin Infect Dis. 2015 Oct 1;61(7):1127-34.
Phase 3 trials of direct acting antiviral drugs (DAAs) for hepatitis C virus (HCV) excluded patients coinfected with human immunodeficiency virus (HIV). After approval, small trials were done in HIV-HCV coinfected patients. The status quo results in delayed access to DAAs for HIV coinfected patients, a group with more rapid progression of liver disease. In this review sustained virological response rates in the HIV coinfected patients are compared to those in the HCV monoinfected treated with the same regimen for the same HCV genotype. SVR rates in HCV genotype 1 to 4 are almost identical in the HIV co-infected as in the HCV monoinfected, regardless of whether the regimens contain interferon. Because HIV coinfection does not affect sustained virologic response rates or toxicity with DAA-containing therapy, excluding HIV coinfected patients from clinical trials of DAA-containing anti-HCV therapy is discriminatory and unnecessary. Rather, HIV coinfection is one of many comorbidities that occur in some patients with HCV infection. One important condition is that in HCV coinfected patients HIV disease be controlled and drug-drug interactions appropriately managed.
Commentary: this view point is an excellent summary of available result of DAA-containing therapy for HCV in HIV coinfected patients. It clearly demonstrates that HIV infection does not negatively affect response rate of modern anti-HCV therapy when compared to HCV monoinfected patients.
