Unsuccessful direct-acting antiviral Hepatitis C treatment among people with HIV: Findings from an international cohort
Successful treatment of hepatitis C virus (HCV) infection with direct-acting antivirals (DAAs) is now expected in almost all people with HIV (PWH). However, a small proportion still do not achieve cure, and understanding the reasons for unsuccessful treatment remains important for achieving HCV elimination goals. In this study, Harney et al. investigated factors associated with unsuccessful DAA treatment among PWH using data from the International Collaboration on Hepatitis C Elimination in HIV Cohorts (InCHEC), which includes data from the Swiss HIV Cohort Study and other international cohorts.
The study included 4’468 people with HIV and HCV who initiated DAA treatment. The median age was 50 years, 44% were gay or bisexual men, followed by 25.6% who were male and had a history of intravenous drug use, and 18% had evidence of liver cirrhosis. HCV treatment success could be determined among 4098 individuals, of whom 3’891 (95%) were successfully treated. Among those tested, unsuccessful treatment was observed in only 5%, confirming the high overall effectiveness of DAA therapy in this population. Unsuccessful treatment was associated with lower CD4+ cell counts, infection with an HCV genotype 4 , and recent injecting drug use, although most people who reported recent injecting drug use (92 %) were successfully treated.
In summary, this large international study confirms that DAA treatment achieves cure in nearly all people with HIV and HCV co-infection. Nevertheless, individuals with low CD4+ cell counts or ongoing injecting drug use may benefit from additional support and monitoring during HCV treatment to maximise the likelihood of cure.