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Hepatitis C in HIV-Infected Patients: Impact of Direct-Acting Antivirals

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Abstract

Approximately 30 % of HIV-infected patients are co-infected with hepatitis C virus (HCV). After the release of highly active antiretroviral therapy, liver disease has become the leading cause of morbidity and mortality in HIV patients. Prior to 2011, HCV treatment with pegylated-interferon and ribavirin in HCV/HIV co-infected patients only allowed 14–38 % of patients with HCV genotype 1 to achieve a sustained virologic response (SVR). Additionally, treatment was commonly discontinued as a result of adverse events. Recently, simeprevir and sofosbuvir have been approved by the US Food and Drug Administration (FDA) for HCV mono-infection. Sofosbuvir has been given FDA approval in co-infected patients offering unprecedented SVR rates and the potential for interferon-free therapy. HCV therapies that are in the pipeline offer improved treatment times, safety profiles, and rates of SVR. Despite these improvements, several new issues including adherence, drug–drug interactions with antiretroviral therapies, adverse events, resistance, and patient selection may complicate therapy. This article reviews the current status of direct-acting antivirals (DAA)-containing regimens for HIV/HCV co-infected patients in the USA. New results investigating telaprevir and boceprevir are also discussed as they are relevant for locations where new DAAs are not available. The impact future interferon-free therapies may have on co-infected patients is also discussed.

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Acknowledgments

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Conflict of interest

Kian Bichoupan is a paid consultant of Kadmon, Gilead Sciences, and Janssen Pharmaceuticals.

Dr. Douglas T. Dieterich serves as a paid lecturer and consultant, and is a member on scientific advisory boards of companies that either develop or assess medicines used for the treatment of viral hepatitis. These companies include Bristol-Myers Squibb, Gilead Sciences, Boehringer Ingelheim, Idenix, Merck, and Janssen Pharmaceuticals.

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  1. Icahn School of Medicine at the Mount Sinai School of Medicine, New York, USA

    Kian Bichoupan & Douglas T. Dieterich

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Correspondence to Douglas T. Dieterich.

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Bichoupan, K., Dieterich, D.T. Hepatitis C in HIV-Infected Patients: Impact of Direct-Acting Antivirals. Drugs 74, 951–961 (2014). https://doi.org/10.1007/s40265-014-0232-6

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