The World Health Organization estimates that globally, 5-15% of people living with HIV are coinfected with hepatitis C. In the United States, about 25% of people living with HIV also have hepatitis C (HCV)—and HCV rates are even higher among people with HIV who inject drugs. For both hepatitis B and hepatitis C infection, disease progresses faster and causes more liver-related health problems among people with HIV than among those who do not have HIV infection. According to the Centers for Disease Control and Prevention [PDF 328 KB], people who are coinfected with HIV and HCV are nearly three times more likely to develop liver disease, liver failure, and liver-related death from HCV than people with HCV alone.
Averting these dangerous health outcomes has been a challenge for people with HIV/HCV coinfection because many previous treatments for HCV were not recommended for people with HIV. These older treatments included interferon and other drugs with side effects that were often severe and included potential adverse interactions with HIV drugs.
AIDS 2014 Researchers Highlight Promising Treatments for People with HIV/HCV Coinfection
Last month, more than 13,000 researchers, public health leaders, clinicians, people living with HIV, and advocates from around the world gathered in Melbourne, Australia for the 20th International AIDS Conference (AIDS 2014 ). Included among the hundreds of presentations were research findings from studies of two interferon-free treatments showing high cure rates in people with HIV/HCV coinfection. Although previous studies have shown that newer HCV treatments have fewer side effects, shorter duration of treatment, and higher cure rates, they had not been evaluated in people with HIV/HCV coinfection.
TURQUOISE-I Study Reveals 94% Cure Rate Using All Oral Therapy for People with HIV/HCV Coinfection
In the TURQUOISE-1 study, researchers found a 94% cure rate after 12 weeks on AbbVie’s oral regimen of three direct-acting antivirals plus ribavirin for people with HIV and genotype 1 HCV coinfection. The 94% cure rate was identified in part one of the study, following 63 people also taking HIV treatments including either atazanavir (Reyataz®) or raltegravir (Isentress®) with undetectable HIV viral load. Later this year, researchers will begin part two of the phase III trial, testing the oral regimen in people with HIV/HCV coinfection who take Prezista® for HIV. The study evaluated interactions with HIV drugs and is being conducted by Dr. Mark Sulkowski from Johns Hopkins University School of Medicine. Watch Dr. Sulkowski’s AIDS 2014 presentation of TURQUIOSE-I results on YouTube .
PHOTON-1 and 2 Studies Demonstrate a Range of Outcomes for People with HIV/HCV Coinfection
In the PHOTON-1 study, individuals with HIV/HCV coinfection were given an oral, interferon-free combination of Gilead’s sofosbuvir (Sovaldi®) and ribavirin for 12 or 24 weeks. Cure rates ranged from 67 to 94% depending on HCV genotype and previous treatment response. This study was also led by Dr. Sulkowski and results are available in the Journal of the American Medical Association (JAMA) .
The PHOTON-2 study , led by Dr. Jean-Michel Molina from University of Paris Diderot, found that a combination of sofosbuvir and ribavirin, taken for 24 weeks, resulted in 84% to 89% cure rates in HIV/HCV coinfected patients in Europe and Australia. Findings show that cure rates varied depending on HCV genotype and the presence of liver cirrhosis. Researchers found a 100% cure rate among participants with HCV genotype 1, subtype 1b, but 75% cure for those with the same genotype who had cirrhosis. Their analysis found cirrhosis to be the only significant risk factor for a poor treatment response, which indicates the importance of ensuring people have access to timely treatment, before liver damage progresses to cirrhosis.
“These scientific advances represent tremendous opportunities to improve care for people living with HIV/HCV coinfection,” said Dr. Ronald Valdiserri, Assistant Secretary for Health, Infectious Diseases. “The research presented at AIDS 2014 brings us closer toward achieving the goals of both the Viral Hepatitis Action Plan and the National HIV/AIDS Strategy.”