The author of a related editorial notes that treatment of hepatitis C in patients with HIV co-infection has been limited by the reluctance of many HIV clinicians to use interferon alfa and the hesitation of many hepatologists to treat persons with HIV.
The TURQUOISE-I trial, and another study published alongside this early online in JAMA, investigated two all-oral direct-acting antiviral regimens in this patient population. Whereas the TURQUOISE-I trial included both HCV treatment-naive or those previously treated (with pegIFN plus ribavirin), and also those with Child-Pugh A cirrhosis, the other investigated a more narrowly defined group of patients with HIV and HCV co-infection without prior HCV treatment and also without cirrhosis.
The editorial notes that the regimens were associated with SVR rates in patients co-infected with HIV/HCV that are similar to those achieved in HCV-monoinfected patients. In the era of pegIFN plus ribavirin, the SVR rate for patients co-infected with HIV was lower than that achieved with HCV monoinfection; direct acting antivirals appear to have closed this gap. This is also apparent for the previously observed differences in SVR rates between black and white patients treated with pegIFN plus ribavirin. Although 50% of the population of the current two studies were black, only three patients (out of a total population of 113) experienced virological failure.
Although no patients discontinued study medication due to adverse events, 10% had to reduce their ribavirin doses due to anaemia; close monitoring of haemoglobin levels should therefore be undertaken.
The author notes that based on the high observed SVR rates, future barriers to prevention of unnecessary deaths due to HCV may be related to failures of the health care system. Clinicians who treat patients with hepatitis C must facilitate harm reduction measures as well as provide antiviral treatment to achieve the ultimate goal of eradication of hepatitis C.