Although direct acting antivirals (DAAs) have revolutionized the treatment of hepatitis C virus (HCV), a small fraction of patients still experience treatment failure. In an editorial in a special issue of the journal Viruses, Che Colpitts, PhD, and Thomas Baumert, MD, of the Institute of Research of Viral Maladies in Strasbourg, France, describe why the research included is important to the future of treating HCV.
“In the USA, chronic hepatitis C infection, the most common cause of liver-related death and liver transplantation, recently surpassed human immunodeficiency virus (HIV) infection as a cause of mortality,” say the authors in the introduction. Patients who do not reach sustained virological response (SVR) are more likely to have a resistant variant. The class of DAA, the genotype of HCV, and the patient group are all factors in the mechanisms of resistance.
The authors point out that, “given that the outcome of DAA-based therapies may be affected by the selection of resistant variants, virological tools to monitor drug resistance both in the drug development stage as well as in the clinic are of critical importance.” There are some diagnostic tools which monitor HCV-resistance, and resistance does not necessarily mean treatment cannot be successful.
Study Aims and Results
The study sought to understand the effects of treatment with sofosbuvir-containing therapies on people requiring hemodialysis. Hemodialysis is a process of filtering the blood of a person when the kidneys are not working normally. This was a prospective study. Patients received sofosbuvir once daily (7 patients) or 3 times a week (5 patients) after hemodialysis treatment. Sofosbuvir was given with either simeprevir, daclatasvir, ledipasvir or ribavirin.
It was found that all of the patients tolerated the medications. Two relapses occurred in the 3 times a week group but no one relapse in the daily group.
It was found that sofosbuvir could be safely administered but that close monitoring should be given to hemodialysis patients. They also noted that more data is needed to safely and effectively treat hemodialysis patients.
HCV liver disease progression can increase the risk of severe kidney disease progression. It is important to have effective therapies to treat hepatitis C that are safe for people with severe kidney disease. In clinical trials, Zepatier was shown to be safe and effective in people with kidney disease and hepatitis C. Until more clinical studies are conducted on sofosbuvir containing therapies, Zepatier is a safe alternative to sofosbuvir containing therapies for people on hemodialysis.
Source: J Hepatol. 2016 Jul;65(1):40-7. doi: 10.1016/j.jhep.2016.02.044. Epub 2016 Mar 4.
Despite increasing use of antiretrovirals, no reduction in end-stage liver disease risk was observed among patients coinfected with HIV and viral hepatitis during a 15-year period, according to an analysis of data from The North American AIDS Cohort Collaboration on Research and Design.
“Patients triply infected with HIV, hepatitis C virus and hepatitis B virus were at particularly high risk, having a 12-fold higher incidence rate of [end-stage liver disease (ESLD)] compared with HIV monoinfected patients, even in the modern ART era,” Marina B. Klein, MD, MSc, FRCPC, professor in the division of infectious diseases at McGill University, and colleagues wrote. “Even after accounting for competing risks of death, CD4 and HIV RNA suppression, we observed no apparent improvement in ESLD rates in our HIV/HCV coinfected population.”
Although patients with HIV who are coinfected with HBV or HCV are at increased risk for ESLD, whether use of modern ART reduced that risk was unknown.