The Clinical Impact Of Hcv Clearance With Direct Antiviral Agents, In A Cohort Of Hiv/Hcv Coinfected Individuals

Background: HCV infection has been associated with both liver and non-liver related morbidity. The impact of HCV clearance on non-liver related morbidity is not fully defined. We sought to evaluate the effect of HCV clearance on liver and non-liver related morbidity among HIV/HCV co-infected individuals. Methods & Materials: Data was drawn from medical charts of HIV/HCV-coinfected patients who received direct antiviral agents (DAA)-based therapy between 01/2016-07/2017 in a tertiary hospital in Buenos Aires. Changes in clinical manifestations between end of treatment and baseline were assessed using non-parametric tests. Results: Among the 35 included HIV/HCV co-infected patients, 72% were male and the mean age was 51.2(SD 6.7years). At DAA treatment initiation, 31(86%) were receiving integrase inhibitor-based antiretroviral therapy; all were virally suppressed, and mean CD4 count was 512 cells/μL(SD 392). Regarding HCV infection, the most prevalent genotype was 1(28,80%),mean baseline HCV- viral load was 5.9 log10(SD 0.6), 31(87%) had METAVIR F4, 6(17%) esophageal varices, and 13(36%) a history of previous IFN-based treatment. All individuals received sofosbuvir/daclatasvir for 12 or 24 weeks, and 22(61%) also received ribavirin. All achieved end of treatment response, and among the 18 cases with ≥12 weeks from end of treatment, all achieved sustained virological response(SVR). After ETR/SVR, improvements were seen in dermatological manifestations (6/6), fatigue (12/15,p = 0.001), APRI-score(from 1.3 ± 0.8; to 0.7 ± 0.5;p = 0.0003, ALAT (from 98 ± 60IU/mL to 41 ± 16IU/mL,p < 0.0001), ASAT (from 89 ± 59 IU/mL to 39 ± 18IU/mL,p < 0.0001), alfafeto-protein (from 22,9 ± 33.3IU/mL, to 4,8 ± 2,12ng/mL,p = 0,03) and albumin levels (from 3,8 ± 0,4 g/dL to 4.3 ± 0.3,p = 0.01). It was observed a tendency to improvement in fasting blood glucose levels (from 100 ± 29.8 mg/dL to 88.8 ± 11.9 mg/dL,p = 0,08). There were no changes in prothrombin-time, CD4-cell, platelets, hematocrit, WBC and renal function (measured by MDRD). One subject presented variceal bleeding during treatment. Conclusion: In this study, HCV clearance was associated with improvements in liver- and non-liver related manifestations. These phenomena, reflects the impact of HCV clearance on patients’ health and well-being and highlight the benefits of DAA-based treatments in HIV/HCV-coinfected individuals.