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HIV/HCV Coinfection Highlights at the 20th Internaltional Conference on AIDS

Sofosbuvir/ribavirin: PHOTON-2 Study

In the 24-week PHOTON-2 study, rates of sustained virological response (SVR) 12 weeks after the completion of therapy were 84-89% in people with HIV/HCV coinfection.

A total of 247 people living with HIV who had chronic HCV infection (genotypes 1 [41%], 2 [9%], 3 [39%], 4 [11%]) were recruited. The majority of participants (80%) were treatment-naive and 20% had cirrhosis.

Treatment was all oral and consisted of the HCV protease inhibitor sofosbuvir (400mg once daily) with weight-based ribavirin. Almost all the participants received 24 weeks of therapy.

SVR rates 12 weeks after the completion of treatment varied between 89% (genotype 3) and 84% (genotype 4). The overall SVR rate among participants with genotype 1 infection was 85%.

The combination was safe and well-tolerated. The most common adverse events were fatigue, insomnia, headache, nausea and diarrhea. There is also a cost advantage to the sofosbuvir/ribavirin combination is that the latter drug is generic.

Molina JM et al. All-oral therapy with sofosbuvir plus ribavirin for the treatment of HCV genotypes 1, 2, 3 and 4 infection in patients coinfected with HIV (PHOTON-2). 20th International AIDS Conference, abstract MOAB0105LB, Melbourne, 2014.

The TURQUOISE-I study for genotype 1

Another all oral regimen, using an emerging co-formulation achieved a 94% HCV cure rate in people with HIV/HCV coinfection with genotype 1.

The TURQUOISE-I study evaluated the safety and effectiveness of the AbbVie 3D combination – the HCV protease inhibitor ABT-450, a 100mg boosting dose of ritonavir and the NS5A inhibitor ombitasvir (formerly ABT-267) in a once-daily fixed-dose co-formulation, taken with the twice-daily non-nucleoside HCV polymerase inhibitor dasabuvir (ABT-333) and 1000-1200 mg/day weight-based ribavirin.

Most of the study participants had the harder-to-treat HCV genotype 1a infection and 67% were taking HCV therapy for the first time.

Participants were randomized to take treatment for 12 or 24 weeks.
The SVR rate 12 weeks after completing therapy was 94% in the twelve-week arm. Interim results from participants who completed 24 weeks of therapy showed that 95% had an SVR at week 12.

None of the participants experienced serious adverse events treatment-limiting adverse events. Mild/moderate fatigue, nausea and headache were the most common adverse events.

Sulkowski M et al. TURQUOISE-I: safety and efficacy of ABT-450/r/ombitasvir, dasabuvir, and ribavirin in patients co-infected with hepatitis C and HIV-1. 20th International AIDS Conference, abstract MOAB0104LB, Melbourne, 2014.

Source: Reporting from Melbourne for the PRN News: Bill Valenti, MD