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New Treatments for HIV/Hepatitis C Co-infection Presented at ID Week 2103.

Between one third and one quarter of all HIV-infected individuals are co-infected with HCV. Progression of fibrosis is accelerated in co-infected patients, making the need for effective therapies great in this population. Cure rates with ribavirin and pegylated interferon are reduced. Limited data suggests improved responses to triple therapy with the first generation HCV protease inhibitors telaprevir or boceprevir, but at a cost of increased toxicity, regimen complexity and numerous drug-drug interactions. This treatment still leaves a cure inaccessible to many co-infected patients. Studies of new directly-acting antivirals suggest treatment will soon be much easier and more effective in mono-infected patients, but data in co-infected patients are extremely limited. Rodriguez-Torres et al. reported the results of a pilot study of 12 weeks of triple therapy with the HCV NS5B nucleotide polymerase inhibitor sofosbuvir (SOF), ribavirin and pegylated interferon in 23 co-infected patients. Participants were HCV treatment-naive, non-cirrhotic and could be on antiretroviral therapy (ART) with tenofovir, emtricitabine and any of 5 commonly used 3rd agents. All HCV genotypes were permitted, but 15 were genotype 1a and four 1b. A cure (SVR12) was achieved in 91%. The 2 treatment failures included one relapse after completing therapy and one withdrawn consent after 6 weeks. Adverse effects were similar to those commonly seen with ribavirin and peginterferon or antiretroviral agents. This is a very small study but the results are dramatic for this group of predominantly genotype 1 patients. More data will will be needed to confirm these results, to identify optimal therapy for genotypes other than 1 and for cirrhotic patients. It is anticipated that SOF will be approved for clinical use by the end of 2103, making this regimen available for many co-infected patients in need of more effective therapy.

Rodriguez-Torres M, Rodriguez-Orengo J, Gaggar A, et al. Sofosbuvir and Peginterferon alfa-2a/Ribavirin forTreatment-Naıve Genotype 1−4 HCV Infected Patients who are HIV Coinfected with HIV. ID Week 2013, San Francisco, CA, October 2-6, 2013, abstract 714.

Source: Reporting from San Francisco for PRN News: David H Shepp, MD