Interferon-free therapy for treating hepatitis C virus in difficult-to-treat HIV-coinfected patients
Por:
Mínguez C, García-Deltoro M, Flores J, Galindo MJ, Montero M, Reus S, Carmena J, Masiá M, Amador C, Ortega E and COINFECOVA-2 Study Grp
Publicada:
28 ene 2018
Resumen:
Background/aims: Data regarding the use of all-oral direct-acting antivirals in HIV/hepatitis C virus (HCV)-coinfected patients with advanced liver fibrosis are required, because they are generally under-represented in clinical trials. This study sought to evaluate the use of these drugs in a cohort of coinfected patients, mostly with factors that have previously been recognized as predictors of treatment failure.
Methods: COINFECOVA-2 is an observational, multicenter study conducted in Eastern Spain. Data of all HIV/HCV-coinfected patients treated with direct-acting antiviral under real-life conditions were retrospectively collected, and factors associated with treatment success or safety were analysed.
Results: Among 515 included patients, 96% were on antiretroviral therapy and 89.5% had an HIV-RNA less than 50 copies/ml. HCV genotype (G) distribution was 47% G-1a, 20% G-4, 14.4% G-1b, and 12.8% G-3. Patients with cirrhosis were 54.2%, and 46% failed to prior HCV-therapies. Overall, 92.8% patients (95% confidence interval: 90.2-94.9) achieved sustained virologic response (SVR12). Cirrhosis was the only factor associated with treatment failure, and SVR12 rate was significantly lower in patients with liver stiffness at least 21 kPa. Adverse events were reported in 36.7%, but only two patients (0.4%) discontinued treatment because of adverse events. The bivariate analysis showed an association between ribavirin use and an increased risk of adverse events (odds ratio 2.84; 95% confidence interval: 1.95-4.1; P <= 0.0001).
Conclusion: This heterogeneous cohort of coinfected patients showed a high rate of SVR12. Among cirrhotic patients, those with a liver stiffness at least 21 kPa had a higher probability of treatment failure. Ribavirin use seems to increase the appearance of adverse events. Copyright (C) 2018 Wolters Kluwer Health, Inc. All rights reserved.
Filiaciones:
Mínguez C:
Hosp Gen Univ Castellon, Internal Med Dept, Infect Dis Unit, Castellon De La Plana, Spain
Internal Medicine Department/Infectious Diseases Unit, Hospital General Universitario de Castellon, Castellon de la Plana
García-Deltoro M:
Consorcio Hosp Gen Univ Valencia, Infect Dis Dept, Valencia, Spain
Infectious Diseases Department, Consorcio Hospital General Universitario de Valencia
Flores J:
Hosp Arnau Vilanova, Internal Med Dept, Lleida, Spain
Internal Medicine Department, Hospital Arnau de Vilanova
Galindo MJ:
Hosp Clin Univ, Infect Dis Unit, Internal Med Dept, Valencia, Spain
Internal Medicine Department/Infectious Diseases Unit, Hospital Clinico Universitario
Montero M:
Hosp Univ & Politecn La Fe, Internal Med Dept, Infect Dis Unit, Valencia, Spain
Internal Medicine Department/Infectious Diseases Unit, Hospital Universitari i Politecnic La Fe, Valencia
:
Hosp Gen Univ Alicante, Internal Med Dept, Infect Dis Unit, Alicante, Spain
Internal Medicine Department/Infectious Diseases Unit, Hospital General Universitario de Alicante, Alicante
Carmena J:
Hosp Univ Dr Peset, Infect Dis Unit, Internal Med Dept, Valencia, Spain
Internal Medicine Department/Infectious Diseases Unit, Hospital Universitario Dr Peset, Valencia
Internal Medicine Department/Infectious Diseases Unit, Hospital Universitario Dr Peset, Valencia
Masiá M:
Hosp Gen Univ Elche, Internal Med Dept, Infect Dis Unit, Elche, Spain
Internal Medicine Department/Infectious Diseases Unit, Hospital General Universitario de Elche, Elche
Amador C:
Hosp Marina Baixa, Internal Med Dept, Infect Dis Unit, La Vila Joiosa, Spain
Internal Medicine Department/Infectious Diseases Unit, Hospital Marina Baixa, La Vila Joiosa, Spain
Internal Medicine Department/Infectious Diseases Unit, Hospital Marina Baixa, La Vila Joiosa, Spain
Ortega E:
Consorcio Hosp Gen Univ Valencia, Infect Dis Dept, Valencia, Spain
Infectious Diseases Department, Consorcio Hospital General Universitario de Valencia
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