Coinfection

EASL 2016: Does Having HIV Affect Response to Hepatitis C Treatment?

A study from the U.S. Veterans Health Administration found that HIV-positive people responded as well as those without HIV to direct-acting antiviral (DAA) therapy for hepatitis C, while a Spanish study showed that HIV/HCV coinfected people were less likely to be cured. These conflicting findings, presented at the European Association for the Study of the Liver's International Liver Congress (EASL 2016) last month in Barcelona, indicate that the interactions between HIV and hepatitis C are still not fully understood.alt

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EASL 2016: Sofosbuvir/ Velpatasvir Cures 95% of HIV/HCV Coinfected People

A dual regimen of sofosbuvir plus velpatasvir was well-tolerated and highly effective against hepatitis C virus (HCV) genotypes 1 through 4 in HIV-positive people with chronic hepatitis C coinfection, according to results from the Phase 3 ASTRAL-5 trial presented at the 2016 EASL International Liver Congress last week in Barcelona.

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CROI 2016: Sofosbuvir/ Velpatasvir for Hepatitis C Can Be Administered with Most Antiretrovirals

Sofosbuvir/velpatasvir, a forthcoming combination that effectively treats all hepatitis C virus (HCV) genotypes, can be safely used with most boosted antiretrovirals for HIV/HCV coinfected people, according to a study presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2016)last week in Boston.

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CROI 2016: Hepatitis C [VIDEO]

New interferon-free treatment for hepatitis C virus (HCV) has brought about a revolution in treatment, but challenges still remain -- among them too few people with HCV being diagnosed and the high cost of the new drugs -- before the mission can be declared a success. A panel of hepatitis C experts discuss research presented at the recent 2015 Conference on Retroviruses and Opportunistic Infections(CROI) in Seattle with HIVandHepatitis.com editor Liz Highleyman in this IFARA video.

 

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Coverage of the 2016 Conference on Retroviruses and Opportunistic Infections

HIVandHepatitis.com coverage of the 2016 Conference on Retroviruses and Opportunistic infections (CROI 2016), February 22-25, 2016, in Boston.

Conference highlights include PrEP and other HIV prevention innovations, new HIV treatment strategies, HIV cure research, the cascade of care, HIV-related conditions, and optimizing therapy for hepatitis C.

HIVandHepatitis.com coverage by topic

CROI website

2/26/16

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CROI 2016: Advances in Hepatitis C Research [VIDEO]

Interferon-free therapy can now cure most patients with chronic hepatitis C, but challenges still remain, including persistent liver damage and cancer risk and HCV reinfection after successful treatment. A panel of hepatitis C experts discuss research presented at the recent Conference on Retroviruses and Opportunistic Infections (CROI 2016) and related news with HIVandHepatitis.com editor Liz Highleyman in this IFARA video update.

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CROI 2016: Harvoni for 6 Weeks Cures HIV+ People with Acute HCV if Viral Load is Low

An interferon- and ribavirin-free regimen of sofosbuvir/ledipasvir (Harvoni) taken for just 6 weeks was enough to cure HIV-positive people with recent hepatitis C virus (HCV) infection if their HCV viral load was low, but those with high HCV levels may need longer treatment, according to study findings presented at the Conference on Retroviruses and Opportunistic Infections (CROI 2016)this week in Boston. Presenter Jürgen Rockstroh of the University of Bonn predicted that HCV viral load will become a key factor when making decisions about treating acute hepatitis C.

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Studies done in the interferon era showed that treating people during the acute stage of HCV infection led to much higher response rates and required a shorter duration than interferon-based therapy started during chronic infection.

The advent of direct-acting antivirals (DAAs) in interferon-free regimens has made chronic hepatitis C treatment shorter, better tolerated, and more effective, and many experts expected the same would be true for acute HCV infection. But a combination of sofosbuvir plus ribavirin taken for 12 weeks produced a sustained response rate of only 59% in a small study of HIV-positive men with acute hepatitis C presented at the recent 2015 AASLD Liver Meeting.

There are currently no specific direct-acting antiviral regimens approved for the treatment of acute HCV infection. Current guidelines recommend using the same DAA options as for chronic infection, or even continuing to use interferon and ribavirin.

Rockstroh and colleagues conducted a study to evaluate the safety and efficacy of short-duration treatment using the HCV NS5B polymerase inhibitor sofosbuvir and the NS5A inhibitor ledipasvir for HIV-positive people with genotype 1 or 4 acute hepatitis C.

The analysis included 26 HIV-positive participants at 5 sites in Germany and the U.K. All were men, most were white, and the mean age was 41 years. They had acute HCV infection, defined as a positive HCV RNA test following a negative HCV antibody or RNA test within the past 6 months, or elevated ALT/AST during the past 6 months with no other known cause. About two-thirds had HCV genotype 1a and the rest genotype 4; the mean HCV viral load at baseline was 5.4 log IU/mL.

Participants could either be on antiretroviral therapy (ART) with suppressed HIV viral load or not on ART with no plans to start. Treated patients were using a variety of antiretrovirals that can be co-administered with sofosbuvir/ledipasvir. The most common regimens were efavirenz (Sustiva), raltegravir (Isentress), dolutegravir (Tivicay), or boosted atazanavir (Reyataz) plus tenofovir/emtricitabine (the drugs in Truvada).

All participants in this open-label study received sofosbuvir/ledipasvir in a fixed-dose coformulation for 6 weeks.

The usual recommended duration of sofosbuvir/ledipasvir for chronic hepatitis C treatment is 12 weeks, though easier-to-treat patients with no prior treatment experience, no cirrhosis and low viral load can be treated for 8 weeks.

Results

  • After 6 weeks of therapy and 12 weeks of post-treatment follow-up, 20 of 26 participants (77%) achieved sustained virological response (SVR12), or continued undetectable HCV RNA.
  • 4 patients experienced virological failure -- 2 relapses and 1 reinfection with a different HCV genotype -- and 2 were lost to follow-up.
  • All 3 relapsers had high baseline HCV viral load above 7.0 logIU/mL; 2 had genotype 1a and 1 had genotype 4.
  • No new NS5A or NS5B resistance-associated viral variants were detected at the time of relapse.
  • Treatment was generally safe and well-tolerated with 1 unrelated serious adverse event and no treatment discontinuations for this reason.
  • The most common adverse events were fatigue (7%), nasopharyngitis (7%), and headache 6%), mostly mild or moderate.
  • Safety profiles were similar for patients receiving boosted or unboosted tenofovir-based ART regimens.

Given that there were no relapses among participants with baseline HCV RNA <6.9 log IU/mL, the researchers concluded, "acutely HCV-infected patients with a higher viral load should be considered for longer duration of therapy."

Rockstroh noted that although shorter interferon-based treatment works well for acutely infected patients, "unfortunately DAAs don't behave the same way."

He acknowledged that it is still not clear when is the best time to treat people with acute HCV infection. About 25% of all people and 15% of HIV-HCV coinfected people with acute infection will spontaneously clear the virus. Many experts recommend waiting to see if treatment is really needed, but the likelihood of transmitting HCV during this early period can be high.

When considering guidelines for acute hepatitis C treatment, "everything is going to be driven by viral load," Rockstroh predicted.

2/26/16

Reference

JK Rockstroh, S Bhagani, RH Hyland, et al. Ledipasvir/Sofosbuvir for 6 Weeks in HIV-Infected Patients With Acute HCV Infection. Conference on Retroviruses and Opportunistic Infections. Boston, February 22-25, 2016. Abstract 154LB.

More Than 2 Million People Worldwide Are Coinfected with HIV and Hepatitis C

Approximately 2.3 million people are living with both HIV and hepatitis C virus (HCV), about half of whom are people who inject drugs, according to a meta-analysis of nearly 800 studies published in the February 24 advance online edition of The Lancet. The analysis found that the overall likelihood of people with HIV being coinfected with HCV is about 6%, but good data are lacking for many countries.

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AASLD 2015: U.S. Faces Biggest Burden of Hepatitis C Treatment Costs Before 2020

The cost of treating hepatitis C is likely to decline dramatically over the next decade in the U.S., not because of cuts in drug prices, but because the population in need of treatment will shrink by 2020 as a majority of patients will already have been treated, according to research by Jagpreet Chhatwal of Massachusetts General Hospital and colleagues presented at the AASLD Liver Meeting in San Francisco last month.

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