Can an 8 Week Treatment Eliminate HCV in Black Patients Co-Infected with HIV?

In 2014, the US Food and Drug Administration approved ledipasvir-sofosbuvir (LDV-SOF) as an 8-week treatment of hepatitis C virus (HCV). Current guidelines, however, recommend a 12-week treatment for patients co-infected with HIV. LDV-SOF clinical trials consisted of limited findings concerning black co-infected patients, a population historically underrepresented in HCV clinical trials.

A recent study, presented in an oral abstract session at the Association of Nurses in AIDS Care Conference (ANAC 2019), examined black HIV and HCV co-infected patients who completed 12 weeks of LDV-SOF treatment in order to assess their HCV RNA over the course of treatment and determine whether viral suppression occurred at 8 weeks.

The 3 black male patients who met inclusion criteria were ages 59, 58, and 56 years. Charts were taken from an HIV primary care clinic in the Southern United States between January 2015 and February 2017.

A retrospective chart review examined virologic response at 4, 8, and 12 weeks after initiation of LDV-SOF treatment. Criteria included attending all appointments for HCV RNA assessment and completion of treatment. The sample size was small because several patients missed appointments or did not complete 12 weeks of treatment.

The 3 patients had pre-treatment HIV-1 RNA/ml of <70 copies and CD4 helper counts of >600uL, indications of well controlled HIV and consistent adherence to antiretroviral medications. By week 8, HCV-RNA was not detected for the patients in the case series.

Investigators noted that because black co-infected patients are regarded as a hard to reach treatment population, and because co-infected patients have greater liver-related morbidity and mortality, it is essential that individuated treatment approaches be developed. The small sample size itself points to difficulties maintaining treatment over a full 12-week course.

Abstract authors wrote that “a shorter duration of treatment would be an ideal approach to potentially improve medication adherence and significantly reduce health care costs by approximately $30,000 per person” and that “based on the results of this case series, efficacy of a shorter duration of treatment should be explored in a larger sample size of black co-infected patients.”