This article previously appeared in HIVupdate, a publication of aidsmap.com
There’s more good news on treatment for hepatitis C. In several trials of new hepatitis C drugs involving people with hepatitis C and HIV co-infection, over 90% of HIV-positive people had no traces of hepatitis C after 12 weeks of treatment. The drug regimens are made up of tablets only, often with more than one drug combined into a single tablet, and no injections of interferon are needed.
Until recently, it was thought that recommendations for treating people who have HIV and hepatitis C co-infection had to be different from those 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 we now know that when a potent combination of two or three new hepatitis C drugs is taken, people with HIV co-infection can have results that are comparable to people who only have hepatitis C.
In the following studies, people were generally already doing well on HIV treatment, with undetectable viral loads and good CD4 counts. But most had hepatitis C genotype 1a, which until now has been considered ‘hard to treat’. And most had an inherited gene which meant that they would probably not do well on hepatitis treatment that includes interferon injections.
The first study tested two new drugs, sofosbuvir and ledipasvir, which are combined in a single tablet called Harvoni. The tablet was approved by European regulators last week. Researchers gave the treatment to 50 HIV-positive people, none of whom had taken hepatitis C treatment before. Most had a high hepatitis C viral load and a quarter had advanced liver fibrosis (but none had cirrhosis, the more serious scarring of the liver). After 12 weeks of treatment, all but one of the patients were cured of hepatitis C.
A rival drug company is offering a regimen which includes three new drugs. This regimen involves a tablet called Viekirax (which combines two new drugs, ombitasvir and paritaprevir, as well as a ritonavir booster), another new drug dasabuvir (Exviera), and the option to take these alongside the existing drug ribavirin. European regulators have given preliminary support to this combination, with a final decision expected next year.
To test this regimen, another small study recruited HIV-positive people who were mostly taking hepatitis treatment for the first time. One in five had liver cirrhosis. Whether people took the drugs for 12 or 24 weeks, over 90% had no traces of hepatitis C after the treatment was finished. A larger trial will confirm which length of treatment is best.
And another study tested the so-far unlicensed combination of two new drugs, grazoprevir and elbasvir. Treatment for people living with HIV was most successful when the combination was taken along with ribavirin – in 97% of people, hepatitis C could not be detected.
In all these studies, side-effects were not a major problem.
Finally, a study showed good outcomes for people living with HIV who had liver transplants. The transplants were all done because the person had hepatocellular carcinoma (HCC, a type of liver cancer that may occur when a person has cirrhosis). People who had a transplant did better than people who had their liver cancer treated in another way. Outcomes after a transplant were as good for people living with HIV as for people who didn’t have HIV. HIV UPdate, a publication of aidsmap.com