HIV Coinfected Have Similar SVR Rates as HCV Monoinfected With DAAs: It's Time to End Segregation and Integrate HIV Patients Into HCV Trials

Phase 3 trials of direct acting antiviral drugs (DAAs) for hepatitis C virus (HCV) excluded patients coinfected with human immunodeficiency virus (HIV). After approval, small trials were done in HIV-HCV coinfected patients. The status quo results in delayed access to DAAs for HIV coinfected patients...

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Bibliographic Details
Published in:Clinical infectious diseases 2015-10, Vol.61 (7), p.1127-1134
Main Author: Shafran, Stephen D.
Format: Article
Language:English
Subjects:
Antiviral Agents - pharmacology
Antiviral Agents - therapeutic use
Antiviral drugs
Clinical Trials as Topic
Coinfection - drug therapy
Coinfection - epidemiology
Coinfection - virology
Comorbidity
Comparative analysis
Genotype & phenotype
Hepacivirus - drug effects
Hepatitis
Hepatitis C - complications
Hepatitis C - drug therapy
Hepatitis C - epidemiology
Hepatitis C - virology
HIV
HIV Infections - complications
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - virology
HIV-1 - drug effects
Human immunodeficiency virus
Humans
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Summary:Phase 3 trials of direct acting antiviral drugs (DAAs) for hepatitis C virus (HCV) excluded patients coinfected with human immunodeficiency virus (HIV). After approval, small trials were done in HIV-HCV coinfected patients. The status quo results in delayed access to DAAs for HIV coinfected patients, a group with more rapid progression of liver disease. This article reviews all approved DAAs and compares sustained virological response (SVR) rates in the HIV coinfected with those in the HCV monoinfected treated with the same regimen for the same HCV genotype. SVR rates in HCV genotype 1 to 4 are virtually identical in the HIV co-infected as in the HCV monoinfected, regardless of whether the regimens contain interferon. Because HIV coinfection does not affect SVR rates or toxicity with DAA-containing therapy, excluding HIV coinfected patients from clinical trials of DAA-containing anti-HCV therapy is discriminatory and unnecessary. Rather, HIV coinfection is one of many comorbidities that occur in some patients with HCV infection.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/civ438