Co-Existing Co-Infection Research Results

By: Marcus J. Hopkins, Blogger

One of the primary focal points of the HEAL Blog’s reporting is based around issues of affording Direct Acting Agents (DAAs) for treating Hepatitis C (HCV). Much of what is written concerns the struggles faced my people mono- or co-infected with HCV who cannot afford the high cost of treatment – and, if we’re being honest, out-of-pocket, few people realistically can afford the treatments unless they have ridiculously good insurance. One issue we infrequently cover, however, is the effectiveness of these DAA drugs on co-infection populations with HIV and HCV.

Chart showing Hepatitis C Direct Acting Antiviral Agents

Photo Source: 2014: HIV, HCV, and HBV Update David Spach, MD Professor of Medicine, Division of Infectious Diseases University of Washington Last Updated: June 12, 2013.

There are a few terms to go over, before we start:

  • SVR – Sustained Virologic Response is the most widely used efficacy endpoint in clinical studies of hepatitis C, and represents the eradication of HCV from the body
  • 2D RegimenOmbitasvir-Paritaprevir-Ritonavir (Technivie).
  • 3D Regimen – Ombitasvir-Paritaprevir-Ritonavir and Dasabuvir (Viekira Pak)

The general assumption in the U.S. has been that co-infected patients attain similar SVR results with DAA drugs as do their mono-infected peers. While outliers always exist, inevitably, someone will come forth with anecdotal evidence demonstrating that their HCV was more virulent than another’s. Two recent studies on the efficacy of DAA HCV drugs in co-infected patients, however, released results that, while not outright contradictory of one another, may lead healthcare providers to pay closer attention to the ratio of co-infected patients who achieve an SVR.

The first study, conducted by the Veterans Health Administration (VHA) determined that the co-infected saw lower SVR rates, but that that rate was lower than their mono-infected peers; the second study showed that the co-infected of achieving that SVR is much lower than their peers. While the first study did not test any of the pegylated-Interferon-based treatments – (1) Sovaldi / Olysio combo; (2) 2D; (3) 3D – while the second study showed the co-infected patients who used the Pegylated Interferon-based regimens were significantly unlikely to achieve an SVRs when compared to those patients who received 2D and 3D therapies.

In the VHA study, patients saw an overall rate of SVR exceeding 88% across the three regimens. While this overall rate still lags behind mono-infected patients, the results in the second study (out of Hospital Universitario de Valme in Seville) demonstrate why the new DAA drugs are so much better. Patients in the second study who received Interferon-based treatments augmented by sofosbuvir (Sovaldi), simeprevir (Olysio), boceprevir, or telapravir saw an SVR rate of only 55% in co-infected patients; mono-infected patients saw an SVR of only 66%.

The second study also found slightly less great news about new DAA drugs: mono-infected patients saw an SVR rate of 95%, while co-infected patients saw a rate of 89%, which may seem insignificant, in terms of interval, but the high cost of HCV therapies makes accessing the therapies for a second round if an SVR is not reached (or for a re-infection) a very pricy endeavor.

While new DAA HCV drugs are undoubtedly more effective than the only medications, there is still a long way to go in order to ensure that all patients, mono- or co-infection, are able to achieve a sufficient SVR rate similar to their peers.

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

 

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