Early emergence of opportunistic infections after starting direct-acting antiviral drugs in HIV/HCV-coinfected patients.

Autor: Macías J; Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain., Téllez F; Infectious Diseases and Microbiology Unit, Hospital Universitario de Puerto Real, Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cadiz, Spain., Rivero-Juárez A; Instituto Maimonides de Investigación Biomedica de Córdoba (IMIBIC), Hospital Universitario Reina Sofia, Cordoba, Spain., Palacios R; Infectious Diseases, Microbiology and Preventive Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain., Morano LE; Infectious Diseases Unit, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain., Merino D; Infectious Diseases Unit, Hospital Juan Ramón Jiménez, Huelva, Spain., Collado A; Infectious Diseases Unit, Hospital Torrecárdenas, Almeria, Spain., García-Fraile L; Infectious Diseases-Internal Medicine Service, Hospital Universitario de la Princesa, Madrid, Spain., Omar M; Infectious Diseases Unit, Hospital de Jaen, Jaen, Spain., Pineda JA; Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain.
Jazyk: angličtina
Zdroj: Journal of viral hepatitis [J Viral Hepat] 2019 Jan; Vol. 26 (1), pp. 48-54. Date of Electronic Publication: 2018 Oct 17.
DOI: 10.1111/jvh.13003
Abstrakt: Varicella-zoster virus and hepatitis B virus reactivations have been reported after starting interferon-free direct-acting antiviral agent (DAA) combinations. HIV/HCV-coinfected patients could be a high-risk group for the reactivation of latent infections. Because of these, we report the occurrence of severe infections after starting DAA regimens in HIV/HCV-coinfected patients. Individuals included in the HEPAVIR-DAA (NCT02057003) cohort were selected if they had received all-oral DAA combinations. A retrospective review of clinical events registered between the start of DAAs and 12 months after SVR12 was carried out. Overall, 38 (4.5%) of 848 patients presented infections. The incidence (95% confidence interval) of infections was 4.6 (3.3-6.3) cases per 100 person-years. The median (Q1-Q3) time to the infection since baseline was 23 (7.3-33) weeks. Five (13%) of the patients with infections died; four of them had cirrhosis. The frequency of previous AIDS was 21 (54%) for patients with infections and 324 (40%) for those without infections (P = 0.084). The median (Q1-Q3) nadir CD4 cell count of individuals with and without infections was 75 (53-178) and 144 (67-255) cells/μL, respectively (P = 0.047). Immunodepression-associated infections were observed in 9 (1.1%) patients. All of them had suppressed HIV replication with antiretroviral therapy. In conclusion, severe infections are relatively common among HIV/HCV-coinfected patients receiving all-oral DAA combinations. Some unusual reactivations of latent infections in patients with suppressed HIV replication seem to be temporally linked with DAA use.
(© 2018 John Wiley & Sons Ltd.)
Databáze: MEDLINE
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