This article previously appeared on aidsmap’s HIV Update of April 16, 2014. Further details are available here.
2014 continues to be a year of extraordinary advances in the treatment of hepatitis C. Four weeks ago, HIV Update summarized studies of several new drugs for hepatitis C presented at a conference in Boston. Since then, another conference – this time in London – has heard encouraging news of even more new drugs and further research into the drugs that were discussed in Boston. In many trials between 95 and 100% of people have been cured of hepatitis C.
In London, new treatment guidelines for hepatitis C were presented.
Until recently, it was thought that recommendations for treating people who have HIV and hepatitis C co-infection had to be different from recommendations for people with hepatitis C mono-infection. This was because people with HIV co-infection tended to have a poorer response to hepatitis C treatment and separate clinical trials were needed.
But it now appears that when a potent combination of two or three hepatitis C drugs (including new drugs) is taken, people with HIV co-infection can have results that are comparable to people who only have hepatitis C.
For example, a study in co-infected people with genotype 1 HCV infection showed a 100% cure rate after twelve weeks of treatment with the combination of sofosbuvir and ledipasvir. This combination is likely to receive European approval in January 2015.
The new guidelines therefore recommend an identical approach for both co-infected and mono-infected people. This means that the new drugs can be made available to people with HIV more quickly, although doctors must be alert to the possibility of drug-drug interactions with HIV medication.
The guidelines recommend that, as much as possible, the newest direct-acting antiviral drugs should be used, even before they have been approved by regulators.
Although some pharmaceutical companies plan to package their firms’ drugs together into a single pill, the guidelines say that the best approach for patients who will be treated in 2014 is to ‘mix and match’ the best drugs from different pharmaceutical companies before any of these combination pills become available.
In the guidelines, different advice is given according to the hepatitis C genotype that a person has. In many cases, the preferred option is a 12-week course of the recently approved sofosbuvir (brand name Sovaldi) plus ribavirin and pegylated interferon injections. However, several other options, including combinations that do not include pegylated interferon, are suggested. For example, six different treatment options are recommended for patients with genotype 1 HCV infection, the most common form of hepatitis C in Europe.