Back HCV Disease Progression Fibrosis/Cirrhosis 10. Hepatitis C Cures for HIV/HCV Coinfected and Advanced Liver Disease

10. Hepatitis C Cures for HIV/HCV Coinfected and Advanced Liver Disease


New interferon-free direct-acting antiviral regimens have high cure rates for chronic hepatitis C patients who were previously considered "difficult to treat," including HIV/HCV coinfected people and patients with liver cirrhosis, decompensated liver disease, and liver transplant recipients. New treatment can now cure a majority of people even with multiple negative predictive factors.

For people with HIV/HCV coinfection, Gilead Sciences sofosbuvir/ledipasvir coformulation (Harvoni) and AbbVie's paritaprevir/ritonavir/ombitasvir plus dasabuvir regimen (Viekira Pak, formerly known as "3D") both demonstrated high cure rates in clinical trials comparable to those for HIV negative people. Merck's investigational grazoprevir/elbasvir combination also looks good for coinfected people.

Another study presented at the AASLD Liver Meeting found that HIV positive people survive as long as HIV negative people after liver transplants. Aside from managing potential interactions between HIV and HCV drugs, many experts now feel that coinfected people are no longer a "special population" -- as shown by the fact that recently approved interferon-free regimens have the same indications for HIV positive and negative patients.

Looking at people with advanced liver disease, both sofosbuvir/ledipasvir and the Viekira regimen produced high sustained virological response rates for liver transplant recipients in clinical studies. Sofosbuvir/ledipasvir also cured most patients with decompensated cirrhosis -- a group that was previously usually excluded from treatment because they could not tolerate interferon.

NEXT: 11. Hepatitis B: Interferon Boosts Cure Rate, Tenofovir Works Long-Term