Direct-acting antivirals are effective and safe in HCV/HIV-coinfected liver transplant recipients who experience recurrence of hepatitis C: A prospective nationwide cohort study
Manzardo C (1), Londoño MC (1,2), Castells L (2,3), Testillano M (4), Montero J L (2,5), Peñafiel J (1), Subirana M (1), Moreno A (6), Aguilera V (7), González-Diéguez ML (8), Calvo-Pulido J (9), Xiol X (10), Salcedo M (11), Cuervas-Mons V (12), Sousa JM (13), Suarez F (14), Serrano T (15,16), Herrero JI (2,17), Jiménez M (18), Fernandez JR (4), Giménez C (9), Del Campo S (6), Esteban-Mur JI (2,3), Crespo G (1,2), Moreno A (1), de la Rosa G (19), Rimola A (1,2), Miro JM (1); FIPSE LT-HIV investigators.
Direct-acting antivirals have proved to be highly efficacious and safe in monoinfected liver transplant (LT) recipients who experience recurrence of hepatitis C virus (HCV) infection.
However, there is a lack of data on effectiveness and tolerability of these regimens in HCV/HIV-coinfected patients who experience recurrence of HCV infection after LT. In this prospective, multicenter cohort study, the outcomes of 47 HCV/HIV-coinfected LT patients who received DAAs therapy (with or without ribavirin [RBV]) were compared with those of a matched cohort of 148 HCV-monoinfected LT recipients who received similar treatment.
Baseline characteristics were similar in both groups. HCV/HIV-coinfected patients had a median (IQR) CD4 T-cell count of 366 (256-467) cells/μL. HIV-RNA was <50 copies/mL in 96% of patients. The DAA regimens administered were SOF+LDV±RBV (34%), SOF+SMV±RBV (31%), SOF+DCV±RBV (27%), SMV+DCV±RBV (5%), and 3D (3%), with no differences between the groups.
Treatment was well tolerated in both groups. Rates of SVR (negative serum HCV-RNA at 12 weeks after the end of treatment) were high and similar for coinfected and monoinfected patients (95% and 94%, respectively; p=0.239). Albeit not significant, a trend towards lower SVR rates among patients with advanced fibrosis (p=0.093) and genotype 4 (p=0.088) was observed.