Coinfection

IAS 2013: HIV/HCV Coinfected People Do Well on HCV Triple Therapy Despite Contraindications

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Nearly three-quarters of HIV/HCV coinfected patients in the French HEPAVIH cohort achieved end-of-treatment virological response to hepatitis C treatment with telaprevir plus pegylated interferon/ribavirin, even though one-third had potential contraindications to this type of therapy, according to a report at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013) this month in Kuala Lumpur.

People with HIV experience more rapid liver disease progression, on average, than people with hepatitis C virus (HCV) alone, and generally do not respond as well to interferon-based therapy. This population has an urgent need for better treatment options, but adding the HCV protease inhibitors boceprevir (Victrelis) or telaprevir (Incivek or Incivo) can increase the risk of side-effects and drug-drug interactions with antiretrovirals for HIV.

Dominique Salmon from Cochin Hospital in Paris and fellow investigators with the ANRS CO13 HEPAVIH cohort study looked at treatment access and outcomes among co-infected patients in a "real-life" clinical practice setting. In clinical trials, triple therapy with boceprevir or telaprevir improved response rates by approximately 30% over pegylated interferon/ribavirin alone, she noted, but trials often have restrictive entry criteria that exclude many people who need treatment in the real world.

The prospective HEPAVIH cohort included 1324 coinfected individuals with genotype 1 HCV who were followed at 24 clinical centers in France between January 2011 and June 2013. The researchers compared outcomes among 320 eligible patients -- 114 (36%) who started triple therapy and 206 (64%) who did not -- looking at contraindications, early treatment response, and adverse events.

Participants, with an average age of about 48 years, had well controlled HIV: 85% had undetectable HIV RNA and the median CD4 count was 555 cells/mm3. About 70% had harder-to-treat HCV subtype 1a.

Salmon did not describe the specific hepatitis C regimens used, but telaprevir triple therapy is usually taken for 12 weeks, followed by pegylated interferon/ribavirin alone for up to 36 more weeks depending on early response, with a full 48-week course recommended for people with HIV. Boceprevir triple therapy lasts for up to 48 weeks, again with a longer course recommended for hard-to-treat patients including those with HIV.

Results

"Triple therapy was started despite potential contraindications to treatment, mainly psychiatric disorders, present in 34% of treated patients," the researchers summarized. "On the contrary, non-treated patients did not have contraindications in 58% of the cases."

"The rate of virological responses at week 24 was high (74% for telaprevir and 60% for boceprevir), with a trend for a better virological response in genotype 1b and non-cirrhotic patients," they concluded.

Salmon added that these results must be viewed with caution until assessment of sustained virological response (SVR), as relapse can occur during the last months of therapy or after the end of treatment. (A cure is typically defined as continued undetectable HCV at 12 or 24 weeks post-treatment, known as SVR12 or SVR24.)

7/19/13

Reference

I Poizot Martin, L Merchadou, P Carrieri, D Salmon, et al. Access to HCV triple therapy with telaprevir or boceprevir in real-life setting in HIV-HCV co-infected patients -- ANRS CO13 HEPAVIH Cohort (France). 7th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention. Kuala Lumpur, June 30-July 3, 2013. Abstract TUAB0102.