The experience of the Moscow City Center for AIDS Prevention and Treatment of using glecaprevir/pibrentasvir in patients with HIV/HCV coinfection

The aim of the study is to analyze the experience of the Moscow Center for HIV/AIDS Prevention and Treatment on antiviral therapy of chronic hepatitis C in patients with HIV/ HCV coinfection in real-world evidence (RWE).

Methods. The data from the outpatient cards of 12 adults and 53 children with HIV/HCV in the Moscow Center for HIV/AIDS Prevention and Treatment were analyzed for the period from 2020 to October 2021. In addition to standard laboratory tests, the viral load of HIV RNA, HCV RNA was examined in all patients, the HCV genotype was determined, the degree of liver fibrosis was assessed by liver fibroelastometry.

Results: Among adult patients 10 (83,4%) were infected with HCV Gt 3, while 2 patients (16,6%) had Gt 1a/3. 5 (41,7%) patients were treatment-naïve and 7 (58,3%) had previously received sofosbuvir and daclatasvir. All 12 adult patients received glecaprevir/pibrentasvir for 8-16 weeks, depending on the treatment experience. 3 (25%) patients with HCV Gt 3 previously treated with DAAs received triple combination of glecaprevir/pibrentasvir, sofosbuvir and ribavirin for 12 weeks. As a result, 100% (12/12) of patients treated with glecaprevir/pibrentasvir achieved SVR12, no adverse events or cases of intolerance were identified.

In the general group of adolescents with HCV/HIV coinfection (n = 53), the distribution by HCV genotypes was as follows: Gt 1 – 26 (49%), Gt 3 – 27 (51%). 15 (28,3%) adolescents received interferon-2a (SVR – 40% (6/15)), 9 adolescents received Peg-interferon-2a (SVR – 33% (3/9)) and 16 adolescents received glecaprevir/pibrentasvir. The mean duration of HIV/HCV coinfection in 16 adolescents receiving glecaprevir/pibrentasvir was 12,5 (1-17) years. Of these, 11 (68,3%) were infected with HCV Gt 1 and 5 (31,7%) with HCV Gt 3. 11 patients (68,3%) had prior treatment history with interferon and peginterferon regimens. The distribution of fibrosis stages was as follows: F0 – 56,3% (9/16), F1 – 31,3% (5/16), F2 – 12,4% (2/16). All 16 adolescents received 8 weeks of glecaprevir/pibrentasvir. 100% of patients were aviremic after 4 weeks from the start of therapy. All patients achieved SVR12. No adverse events and/or intolerance of glecaprevir/ pibrentasvir were identified.

Conclusion. This observation demonstrates the high efficacy and safety of treatment with direct-acting antiviral drugs in both adults and children with HIV/HCV coinfection. Diagnosis and treatment of chronic hepatitis C in patients of reproductive age with HIV/HCV coinfection before pregnancy will help to completely eliminate the risk of mother-to-child transmission of HCV. Timely, effective, and modern antiviral therapy of already infected adolescents with HCV will make it possible to take a step towards eliminating hepatitis C through microelimination in the described socially significant groups of patients

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