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Triple therapy with boceprevir or telaprevir in a E uropean cohort of cirrhotic HIV / HCV genotype 1‐coinfected patients
Author(s) -
Miailhes Patrick,
Gilbert Camille,
Lacombe Karine,
Arends Joop E.,
Puoti Massimo,
Rockstroh Jürgen K.,
Sogni Philippe,
Fontaine Hélène,
Rosenthal Eric,
Winnock Maria,
Loko MarcArthur,
Wittkop Linda,
Dabis François,
Salmon Dominique
Publication year - 2015
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12799
Subject(s) - boceprevir , telaprevir , medicine , ribavirin , gastroenterology , hepatitis c virus , pegylated interferon , discontinuation , adverse effect , hepatitis c , viral load , combination therapy , virology , human immunodeficiency virus (hiv) , virus
Background & Aims The efficacy and safety of triple therapy combining boceprevir ( BOC ) or telaprevir ( TVR ) with pegylated interferon‐alfa and ribavirin (PegIFN/RBV) has rarely been investigated in human immunodeficiency virus/hepatitis C virus ( HIV / HCV ) genotype 1‐coinfected patients with cirrhosis. Methods We conducted a European (France, Italy, Germany, Netherlands) multicentre study of triple therapy in cirrhotic HIV/ HCV GT1‐coinfected patients. Results Fifty‐nine patients (47 TVR , 12 BOC ) were studied. Median CD4 cell count was 457 (293–578)/mm 3 , and HIV viral load was <50 copies/ml in 93% of patients. The HCV genotype was GT1a (78%) or GT1b (13%). Previous PegIFN/RBV therapy had resulted in non‐response (73%) or relapse (12%), and 15% of patients were treatment‐naïve. The sustained virological response rate at week 12 (SVR12) was 53% overall (57% with TVR , 36% with BOC ). A baseline HCV ‐RNA level <800 000 IU/ml tended to be associated with SVR12 (65 vs 42%, P = 0.11). In multivariate analysis, a virological response at week 4 after BOC or TVR initiation was significantly associated with SVR12 ( P = 0.040). Early discontinuation of triple therapy was frequent ( n = 26, 44%), because of non‐response/breakthrough (65%) or adverse events (AEs) (35%). Three patients died. Severe anaemia (<9 g/dl) occurred in 14 patients (25%), leading to RBV dose reduction (22%), erythropoietin use (56%) or blood transfusion (14%). In multivariate analysis, lack of RBV dose reduction was significantly associated with severe AEs ( P = 0.006). Conclusions More than half of HIV/ HCV GT1‐coinfected patients with cirrhosis achieved a SVR12. To avoid unnecessary adverse effects, therapy should be discontinued if no response is obtained at week 4.