Ledipasvir–sofosbuvir for 6 weeks to treat acute hepatitis C virus genotype 1 or 4 infection in patients with HIV coinfection: an open-label, single-arm trial
| Autor: | Christoph Boesecke, Jürgen K. Rockstroh, Robert H. Hyland, Thomas A. Lutz, Patrick Ingiliz, Hadas Dvory-Sobol, Chohee Yun, Wei Zheng, Diana M. Brainard, Mark Nelson, Sanjay Bhagani |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male medicine.medical_specialty Genotype Sofosbuvir Anti-HIV Agents HIV Infections Pilot Projects Hepacivirus Antiviral Agents Drug Administration Schedule Virus 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans 030212 general & internal medicine NS5A Adverse effect Fluorenes Hepatology Coinfection business.industry Gastroenterology Middle Aged Viral Load medicine.disease Hepatitis C Clinical trial Treatment Outcome Acute Disease Immunology Benzimidazoles 030211 gastroenterology & hepatology Uridine Monophosphate business Viral load medicine.drug |
| Zdroj: | The Lancet Gastroenterology & Hepatology. 2:347-353 |
| ISSN: | 2468-1253 |
| Popis: | Summary Background The latest European Association for the Study of the Liver (EASL) guidelines now recommend that patients with acute hepatitis C virus (HCV) infection should be treated with a combination of sofosbuvir and an NS5A inhibitor for 8 weeks. However, the ideal duration of treatment with interferon-free regimens, particularly in HIV-coinfected individuals, remains unknown. We assessed the efficacy and safety of 6 weeks of ledipasvir–sofosbuvir for acute genotype 1 or 4 HCV in HIV-1-coinfected patients. Methods This open-label, single-arm trial, done in Germany and the UK, included patients with acute HCV genotype 1 or 4 and HIV-1. At screening, patients were either receiving HIV antiretrovirals and had HIV RNA less than 200 copies per mL, or not receiving antiretrovirals and had a CD4 T-cell count of greater than 500 cells per μL. All patients received ledipasvir–sofosbuvir once daily for 6 weeks. The primary efficacy endpoint was the proportion of patients with sustained virological response 12 weeks after the end of treatment (SVR12). This study is registered with ClinicalTrials.gov, number NCT02457611. Findings Between June 11, 2015, and Jan 8, 2016, we enrolled and treated 26 patients. All (100%) were men, 24 (92%) were white, and 25 (96%) were receiving antiretroviral treatment. 19 (73%) had genotype 1a and seven (27%) had genotype 4 HCV. Overall, 20 (77%; 95% CI 56–91) of 26 patients achieved SVR12: 15 (79%) of 19 with genotype 1a, and five (71%) of seven with genotype 4. Of six patients not achieving SVR12, three relapsed, two achieved sustained virological response 4 weeks after the end of treatment but were lost to follow-up, and one was reinfected. The most common adverse events were fatigue (seven participants [27%]), nasopharyngitis (seven [27%]), and headache (six [23%]). No patient discontinued or interrupted therapy due to adverse events. No HIV rebound occurred during the study. Interpretation The rate of cure with a fixed-dose combination of ledipasvir–sofosbuvir for patients with acute genotype 1 or 4 HCV infection and HIV-1 coinfection is similar to historic rates with interferon-based treatment, but with shorter treatment duration and more favourable safety outcomes. Funding Gilead Sciences. |
| Databáze: | OpenAIRE |
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