Treatment of HCV and HIV coinfection

Almost every year, the Hepatitis C virus (HCV), a liver disease, is known to infect more than 57 million people worldwide. And the number of deaths caused by this chronic infection is equally overwhelming. Chronic Hepatitis C advances cases of hepatic cirrhosis, hepatocarcinoma and end-stage liver disease.

Revolutionary treatments such as Direct-acting antivirals (DAAs) have been elemental in controlling this epidemic, producing effective results even in patients at an advanced stage of liver cirrhosis caused by HCV. But did you know that most infected patients are unaware of their condition, and the minority who know do not receive the proper treatment?

What is HCV-HIV coinfection

HCV with HIV coinfection is another challenge one must consider when discussing HCV infections. In recent years, the rate of acute HCV infections among certain groups of HIV+ patients, such as PWID (people who inject drugs) and MSM (men who have sex with men), sex workers and those involved in unsafe sexual practices, has accelerated worldwide. A weakened immune system among HIV-infected patients exposes them to a higher risk of HCV infection, resulting in quicker progression to liver cirrhosis and rapid advancement in hepatocellular carcinoma.

A general indication of the severity of this situation: 90% per cent of deaths of non-AIDS HIV+ patients due to liver diseases in the US are attributed to HCV infections. Treatment for HCV and HIV coinfection cases has, therefore, become a priority in the realm of medicine.

In one of our earlier articles, we discussed seroconversion and how to avoid HIV.

A quick word: HHC provides an extensive range of SEROCONVERSION PANELS for detecting asymptomatic donors infected with HIV, HCV, HBV and EBV, and SURVEILLANCE PANELS and LONGITUDINAL PANELS are helping labs diagnose these diseases effectively. Our panels are run on as many different diagnostic kits as possible to measure relevant markers of seroconversion.

In this article, HHC throws light upon the various HCV and HIV coinfection treatment regimens to help curb the increasing mortality rates of coinfected patients.

What are the different treatments for Hepatitis C Virus-HIV-Coinfection?

Some of the following treatments are utilised to treat both HCV monoinfected patients and HCV-HIV coinfected patients. While most treatments are effective, they may also have certain shortcomings.

Due to the added complexity of coinfection with HIV, the treatment pattern for HCV-HIV patients is different. Before suggesting medication to such patients, it is essential to determine the viral load and genotype following serological diagnosis of HCV infection. The duration of treatments varies based on findings from the above investigations.

HHC is a leading supplier of serological controls. With the help of our range of serological controls – the SeraCon Run Controls, labs worldwide can flawlessly assess the performance of immunoassay test procedures for the qualitative determination of HBsAg, anti-HIV and anti-HCV.

Interferon and ribavirin

Though this therapy has been traditionally and primarily practised for treating HCV monoinfected patients, in recent decades, they have also been used to treat the coinfected population. The treatment works, but not without side effects. Interferon can provoke side effects such as tiredness, muscle or joint pain, fever and other flu-like symptoms, loss of white blood cells, nausea or diarrhoea, skin rash, depression, and thinning hair.

Ribavirin is contraindicated in female patients who are pregnant or want to get pregnant and can cause anaemia. In addition, this combination treatment was challenging, lasted a long time (6 to 12 months), could only cure half of the patients under treatment and was mainly administered to patients with high chances of a progression of liver disease.

Direct-Acting Antivirals (DAAs)

Regardless of age, race, sex or HIV status, today, it is possible to cure most hepatitis C patients with direct-acting antiviral (DAA medications. DAAs are safe to use and won’t interfere with HIV treatment because they have few adverse effects. A course of DAA treatments can last up to 12 weeks.

Some DAAs are effective against all genotypes of hepatitis C and can be used as a once-daily combination medication (often referred to as “pangenotypic”), which are well tolerated.

Because DAAs target and attack HCV at various stages of hepatitis C reproduction and lifecycle, the latest DAAs can treat and cure more than 90% of chronic hepatitis C infections. These include hepatitis C protease inhibitors, NS5A inhibitors and polymerase inhibitors.

It is worth noting that, like HIV treatments, a combination of medications is more effective in preventing any resistance that may develop, as they have different ways of working. Hence, most DAAs are only available as part of a combination pill. However, Hepatitis C treatment can cure the patient permanently, unlike HIV treatments.

What are the different types of the DAAs available in the market? 

Boceprevir and Telaprevir were the first DAAs or hepatitis C protease inhibitors approved in 2011. Their range of use was limited to hepatitis C genotype 1 and had to be combined with interferon and ribavirin. These drugs are not recommended anymore.

Some of the recent and better DAA treatments (single and combination) are:

• sofosbuvir (Sovaldi)
• daclatasvir (Daklinza) (could be combined with sofosbuvir)
• simeprevir (Olysio) (could be combined with sofosbuvir)
• sofosbuvir and ledipasvir (Harvoni)
• paritaprevir + ritonavir + ombitasvir (Viekirax) + dasabuvir (Exviera)
• elbasvir + grazoprevir (Zepatier)
• sofosbuvir + velpatasvir (Epclusa)
• glecaprevir + pibrentasvir (Maviret)
• sofosbuvir + velpatasvir/voxilaprevir (Vosevi)

In 2013, the FDA approved simeprevir (Olysio, Janssen) and sofosbuvir (Sovaldi, Gilead). In 2014 a fixed-dose combination of ledipasvir and sofosbuvir (Harvoni, Gilead) was approved. The approved DAAs target genotype 1 and are also effective against genotype 4, except for sofosbuvir + velpatasvir or sofosbuvir + daclatasvir, which are beneficial for genotypes 2 or 3. In some cases, ribavirin could be added to combinations, for instance, for patients with cirrhosis or prior treatment, to increase the possibility of a cure.

How successful are DAA regimens and what are the outcomes? 

Clinical studies reveal an overall success rate between 95 to 100% of recommended DAA combination regimens. If, after 12 weeks, the virus is undetected in patients given a sustained virological response (SVR), the disease has been cured. Although, for certain patients with a rapid progression in liver disease, the SVR rates are lower; with the latest DAAs, most patients are eventually treated.

In some circumstances, it may take a more extended period or a regimen with more medication to be successfully cured. Certain patients might be cured during the second attempt if the first was unsuccessful. DAAs used without Interferon treatment have few side-effects. Mild fatigue, gastrointestinal symptoms and headache are the usual complications which usually go away once the treatment is completed helping the patients’ health to improve.

What the experts have to say about treating HCV-HIV coinfections

According to medical experts, HCV monoinfected and HCV-HIV coinfected patients must have the same treatment recommendations. But to combat the debilitating effects of HCV-HIV coinfection, treatment of coinfected patients should be prioritised.

For all HIV patients, an antiretroviral treatment (ARV) must be initiated soon after HIV is diagnosed, even for HCV-HIV coinfected patients. Starting an ARV regimen in time can restore immunity and control the effects of HIV, which may prove very beneficial, especially for coinfected patients, by reducing the danger of rapid progression in liver disease.

Currently, all coinfected patients are recommended DAA regimens to start with, which becomes even more urgent if the patient has a severe or moderate case of liver fibrosis. ARV and HCV treatment regimens can be recommended simultaneously, and the former must not be interrupted to start the latter. But, besides the initial investigations on the genotypes and serological diagnosis, examining the HIV ARV regimen is essential when planning an appropriate HCV treatment for an HIV coinfected patient. It is vital to ensure that no drug resistance, negative interactions, or side effects are caused by the regimens advised to treat the two viruses.

A better future is only possible with better health services. Your lab needs QUALITY CONTROL PANELS to provide accurate test results to diagnose life-endangering viruses such as HCV and HIV. 

HHC brings you a wide choice of panels that can counter your assays’ sensitivity, specificity and working range or be used for diagnostic development or batch release in manufacturing. Our panels include representative data from current assays on the market. In addition, our range of VERIFICATION / VALIDATION panels is designed to use with assays to determine the presence of antigen, antibody RNA or DNA based upon the intended use of the panel. All testing is performed by Certified Reference Laboratories and Domestic and International Regulatory Bodies.

Don’t hesitate to contact us if you need more information on our products and services. We are happy to answer all your questions regarding our efforts to improve life and health.