Interferon-Free Drugs Effective for Hepatitis C, HIV Co-Infection

Interferon-free, all-oral drug regimens result in high rates of sustained virologic response (SVR) for patients co-infected with hepatitis C virus (HCV) and HIV, potentially removing barriers to preventing needless deaths from HCV, according to 2 studies published in JAMA.

In the first study, researchers evaluated an oral, direct-acting regimen comprised of ombitasvir, paritaprevir co-dosed with ritonavir, and dasabuvir (Viekira Pak) combined with ribavirin in 63 adults with HIV-1 and HCV co-infection, including those with cirrhosis.

Patients were randomly assigned to either 12 or 24 weeks of treatment, and none of the patients had previously received HCV treatment.

In the 12-week group, 94% of patients achieved SVR at least 12 weeks after completion of treatment. Similar success was seen in the 24-week group, where 91% of patients achieved SVR at post-treatment week 12.

For another study, researchers assessed 50 patients co-infected with HIV-1 and HCV genotype 1 who did not have cirrhosis and had never been treated for HCV before. The patients received a combination of ledipasvir 90 mg and sofosbuvir 400 mg (Harvoni) once a day for 12 weeks, and all but 1 was able to achieve SVR 12 weeks after the end of treatment.

In an accompanying editorial, Camilla S. Graham, MD, MPH, of the Beth Israel Deaconess Medical Center in Boston, commented that the high SVR rates seen in the 2 studies suggest “future barriers to prevention of unnecessary deaths due to HCV may be related to failures of the health care system.”

“Clinicians who care for patients with HIV infection are already skilled at selecting regimens, managing drug-drug interactions, optimizing adherence, and providing harm reduction counseling,” Dr. Graham wrote. “These skills are exactly what is needed to treat patients with hepatitis C and to ensure that the successes seen in research trials are replicated in clinical practice.”

Beyond maintaining a relationship with HIV-infected patients, pharmacists can have a positive impact on the management of HCV, Shyam Kottilil MD, PhD, professor and co-director of the Clinical Research Unit in the Institute of Human Virology at the University of Maryland School of Medicine, told Pharmacy Times.

“The major obstacle to treat HIV/HCV co-infected patients is the concern about drug-drug interactions between HIV medications and HCV therapy,” Dr. Kottilil said. “…Pharmacist(s) will have to be counseled regarding potential drug-drug interactions, switching of existing [antiretroviral therapies], and monitoring for drug toxicity. This is mitigated by the reduced impact of [drug-drug interactions] and short durations of [interferon-free] therapy in comparison to earlier therapies.”

The most common treatment-related adverse events were fatigue, insomnia, nausea, and headache in the first trial, and nasal congestion and myalgia in the second trial. None were reported as serious or leading to discontinuation of treatment.