PLWH with HCV respond better to therapy with direct antiviral drugs

In HIV-positive patients with hepatitis C co-infection (HCV), a more pronounced immune response to therapy with direct antiviral agents (DAA) can be observed than in people with HCV monoinfection, it follows from the work published in January in the journal Hepatology Communications.

As is known, in the group of PLHIV with HCV co-infection, due to the association of diseases, a higher rate of progression of liver fibrosis and significantly higher rates of decompensation are observed in comparison with patients infected with HCV only.

However, it was still not entirely clear whether the combination of drugs of direct antiviral effect affects the immunophenotypes and body functions after successful completion of HCV therapy in patients with coinfection.

In this study, researchers evaluated peripheral T-cell immunophenotypes and body functions in patients with HIV and HCV who were successfully treated with combined DAAs.

Experts analyzed peripheral blood mononuclear cells at the initial stage, and during a steady viral response. The participants of the experiment were included in 2 prospective single-center studies of phase 2.

Patients were treated with 3 different combined DAAs.

• daclatasvir and asunaprevir for 24 weeks (CONQUER 2-DAA),
• daclatasvir / asunaprevir / beklabuvir for 12 weeks (CONQUER 3-DAA) and
• sofosbuvir and ledipasvir for 12 weeks (ERADICATE study).

Overall, the findings suggest that PAP combination therapy, which targets the 3 stages of the HCV replication cycle, is more effective when T-cell immunophenotypes change compared to focusing on only 2 viral targets.

An improvement in T-cell activation phenotypes was also observed, demonstrated by a subsequent decrease in CD38 expression and resolution of T-cell activation after CONQUER 2-DAA and 3-DAA therapy.

"Our results require further confirmation in larger studies with comparable baseline demographics," the researchers concluded.