Use of contraindicated antiretroviral drugs in people with HIV/HCV coinfections receiving HCV treatment with direct-acting antivirals-Results from the EuroSIDA study. HIV Medicine
Nikolaichuk et al. on behalf of the EuroSIDA study aimed to assess whether antiretrovirals (ARVs) were used according to the European AIDS Clinical Society (EACS) guidelines for direct-acting antiviral (DAA) therapy of HIV/hepatitis C (HCV-) coinfection in the pan-European EuroSIDA study, and to compare the rate of sustained virological response (SVR) between those who received a contraindicated DAA/ARV combination and those receiving drugs that were not contraindicated.
Among 1’406 people starting DAAs, the median age was 51 years, 75% were male, 57% reported injected drug use as an HIV risk, and 76% were from western Europe. Of 1’624 treatment episodes, 609 (37.5%) occurred while the patient was receiving ARVs with potential contraindications; among them, 38 (6.2%; 95% confidence interval [CI] 4.3–8.2) involved a contraindicated ARV (18 non-nucleoside reverse transcriptase inhibitors), 16 involved protease inhibitors, and four involved integrase strand transfer inhibitors. The adjusted odds of receiving a contraindicated ARV were higher (3.25; 95%CI 1.40–7.57) among participants from east/central east Europe (vs. south) and lower (0.22; 95% CI 0.08–0.65) for 2015–2018 guidelines (vs. 2014). In total, 29 of the 32 (90.6%) patients receiving a contraindicated ARV and 441 of the 461 (95.7%) with potential ARV contraindications experienced a sustained virological response≥12 weeks after stopping treatment (SVR12; p=0.55).
In conclusion, in this large heterogeneous European cohort, more than one-third received DAAs with potential ARV contraindications, but a low proportion received a contraindicated ARV. Use of contraindicated DAA/ARVs declined over time, which corresponds to the increased availability of ART regimens without interactions with DAAs across Europe. Participants who received a contraindicated DAA/ARV combination still had a high rate of SVR12.