Low risk of failing direct-acting antivirals in people with HIV/HCV from Sub-Saharan Africa or Southeastern Asia: a European cross-sectional study. Open Forum Infectious Diseases
Isfordink et al. for EuroSIDA, the Swiss HIV Cohort Study, and the ATHENA Observational Cohort aimed to investigate the real-world efficacy of direct-acting antivirals (DAA) treatment in individuals with HIV/hepatitis C virus (HCV) originating from low- and middle-income countries (LMICs), namely for sub-Saharan Africa (SSA) and Southeastern Asia (SEA) in multiple European cohorts of people with HIV (PWH).
The author group retrospectively analyzed data from the above-mentioned cohorts of PWH. The primary outcome was HCV cure defined as sustained virological response at least 12 weeks after the end of treatment (SVR12).
Of the 3’293 individuals with HIV/HCV treated with DAA and with available SVR12 data, 142 were from SSA (n=64) and SEA (n=78). SVR12 was achieved by 60 (94% [95% confidence interval {CI}, 86%–98%]) individuals from SSA and 76 (97% [95% CI, 92%–99%]) from SEA. The genotypes of the 6 individuals failing DAA treatment were 2, 3a, 3h, 4a, 4c, and 6j. For 2 of the 4 unsuccessfully treated individuals with available sequence data at treatment failure, NS5A resistance-associated substitutions were present (30R/93S in an individual with genotype 4c and 31M in an individual with genotype 6j).
In conclusion, the study shows that DAA efficacy in people with HIV/HCV originating from SSA or SEA and living in Europe is high. Although the limited number of participants with genotypes of concern and the lack of data on location of HCV acquisition limit conclusions on DAA efficacy for individuals with HIV/HCV residing in SSA or SEA, it seems unlikely that suboptimal response to DAAs specific to these individuals could become a complicating factor for overall HCV elimination in Europe in the near future.