Suchergebnisse

In HIV/HCV co‐infected patients improved treatment outcomes have been reported for the HCV protease inhibitors (PIs) boceprevir (BOC) and telaprevir (TVR), reaching SVR rates of up to 70% in pilot trials. Due to complex drug‐drug‐interactions triple therapy is substantially limited in HIV/HCV‐coinfected individuals. Co‐administration of BOC with the commonly available HIV PIs has been reported not only to decrease the level of BOC but also to lead to relevant decreases in the respective HIV PI. Here, we report on two patients who received BOC‐containing HCV triple therapy in combination with a HIV PI. Patient 1 was on darunavir 800 mg/ritonavir 100 mg once‐daily mono‐therapy. Using FibroScan a liver stiffness of 34 kPa suggested liver cirrhosis prior to start of HCV triple therapy. At week 5 of HCV triple therapy darunavir trough concentration was measured in the reference range with 3777 ng/ml (reference trough concentration 2400–4600 ng/ml). HCV‐RNA became negative at week 10 and HIV‐RNA was below detection limit (<40 copies/ml) at all times. Patient 2 was on a simplified FTC qd and fos‐amprenavir 700 mg/ritonavir 100 mg bid regimen. Liver disease had also progressed to liver cirrhosis, confirmed in FibroScan, with a liver stiffness of 32 kPa. At week 8 of HCV triple therapy fos‐amprenavir trough level was measured in the normal reference range with 1699 ng/ml (reference trough concentration 750–2500 ng/ml). At week 11 HCV‐RNA was <12 IU/ml and HIV viral load was below detection limit of <40 copies/ml at all times. Our clinical data suggest that in patients with advanced liver disease possibly drug levels of HIV PIs which are coadministered with BOC may be within the normal range. In order to better understand the true amount of drug interactions between BOC and commonly used HIV PIs in HIV/HCV‐coinfected patients with more advanced liver fibrosis, urgently more PK studies are required to make HCV triple therapy accessible for a wider number of HIV/HCV‐coinfected patients in desperate need of these drugs.

BackgroundIn the last decade, several outbreaks of sexually acquired acute HCV have been described in men who have sex with men (MSM) infected with HIV in Australia, Europe, and North America. The aims of this study were to determine the incidence of acute HCV within the large EuroSIDA cohort and to explore possible regional differences throughout Europe and in different HIV transmission risk groups.MethodsBaseline was defined as 1st Jan of 2002 or entry into EuroSIDA, whichever comes later. All patients from EuroSIDA who were HCV antibody‐negative at baseline and had at least 2 HCV antibody test results available were included into the study. HCV seroconversion was defined as change from negative to positive HCV‐antibody test within the observation period from 2002 onwards. Follow‐up was counted from baseline to HCV antibody positivity for seroconverters and to the last HCV antibody‐negative test result for those that did not seroconvert for HCV. Poisson regression analyses were performed to identify predictive factors for HCV seroconversion.ResultsA total of 150 HCV seroconversions (95 [63.3%] in MSM) occurred in 4295 patients during 18,928 person years of follow‐up (PYFU), overall incidence of 0.79 acute infections per 100 PYFU (95% CI: 0.67–0.92) (see figure). The incidence of HCV seroconversions increased from 0.47 (CI: 0.19–0.74) in 2002 to 2.34 (CI: 1.24–3.44) in 2010. Similar patterns were observed across all European regions (p=0.89, test for interaction). In multivariate analysis, IDU was associated with a higher incidence rate ratio (IRR) than MSM: 4.59 (2.40–8.80; p<0.0001), South and East Europe both had higher IRR compared to Western Europe, respectively (1.98 [1.12–3.49]; p=0.018 and 2.41 [1.41–4.12]; p=0.0014). Calendar year per 2 years was also associated with a higher IRR (1.29 [1.19–1.39]; p<0.0001).ConclusionThe incidence of acute HCV within EuroSIDA increased over time. Although, the incidence of seroconversion was 54% higher in MSM than in heterosexuals, IDUs had the highest incidence of HCV seroconversion. Rising incidences can be found in all European regions highlighting the need for increased prevention efforts in all European countries.
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