LDV/SOF ± RBV, OPrD Effective in HIV/HCV Co-Infected Veterans
BOSTON, MA—Veterans with HIV/HCV GT1 co-infection had high sustained virological response (SVR) rates when treated with ledipasvir/sofosbuvir ± ribavirin (LS ± RBV) or ombitasvir/paritaprevir/ritonavir and dasabuvir (OPrD) ± ribavirin (RBV), according to an observational study of routine clinical practice, reported at The Liver Meeting® 2016.
"In this largely African American real-world HIV/HCV co-infected cohort, SVR rates were similarly high in African Americans and non-African Americans," reported Pamela S. Belperio PharmD, BCPS, Population Health Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, and her colleagues.
Cirrhosis significantly reduced the odds of achieving SVR, she noted.
Using the Veterans Affairs' Hepatitis C Clinical Case Registry, the team identified veterans with HIV/HCV GT1 who initiated 12 weeks of treatment with LS ± RBV or OPrD ± RBV by September 30, 2015 and a drug supply of 8 to 91 days.
SVR was defined as a viral RNA below the limit of quantification (LLOQ) 10 weeks or more after the end of treatment.
“Multivariate models of SVR included age, race, body mass index (BMI), prescribed proton pump inhibitor (PPI) use, HCV treatment experience, GT subtype, cirrhosis, and HIV antiretroviral drug class,” she said.
A total of 996 veterans initiated therapy: 757 with LS; 138 with LS+RBV; 28 with OPrD; and 73 with OPrD+RBV.
SVR rates for LS+RBV-group patients were 89% for non-African Americans, 92.5% for African Americans, 88% for African Americans with cirrhosis, and 100% for African Americans with TRX experience and cirrhosis.
In multivariate analysis, cirrhosis was associated with a significantly lower rate of SVR (odds ratio [OR] 0.50; 95% CI: 0.30–0.85; P=0.008).
"For those on LS ± RBV, receipt of PPIs or an EFV-based regimen in African Americans did not affect SVR," Dr Belperio reported. "Renal function did not worsen on LS regimens with TDF."
The U.S. Department of Veterans Affairs is the largest single provider of care to patients with HIV-HCV co-infection.