COMPARISON OF THE EFFICIENCY OF DIFFERENT TREATMENT SCHEMES FOR PATIENTS WITH CHRONIC HEPATITIS C WITH AND WITHOUT HIV-INFECTION

Abstract

SUMMARY. The aim of the work is to compare the effectiveness of triple and interferon-free regimens of therapy for patients with chronic hepatitis C (CHC) with and without concomitant HIV infection, as well as to compare the obtained results with a number of international studies.

Patients and Methods. 71 patients with CHC were examined, as well as 77 patients with combined HIV infection/CHC. 37 patients with CHC and 22 with HIV infection in combination with CHC received two regimens of therapy: a triple interferon-containing regimen (sofosbuvir 400 mg once a day internally + pegylated interferon alfa-2a at a dose of 180 mg subcutaneously once a week + ribavirin at a dosage of depending on weight: 1000 or 1200 mg/day in persons <75 kg or ≥75 kg, respectively), or a pangenotypic combination of direct-acting antiviral drugs – sofosbuvir 400 mg and velpatasvir 100 mg once a day orally. The duration of therapy according to both schemes was 12 weeks.

The results. Patients in the compared groups did not differ in basic parameters, with the exception of persons with CHC without HIV infection, who were significantly older by age (p<0.05). In the absence of HIV infection, after 4 weeks of interferon-containing therapy of patients infected with non-3rd HCV genotype, 81.3 % of them had a decrease in ALT and AST activity, and 75.0 % of them achieved a virological response. After the 12-week course, the triple therapy showed a biochemical response in 93.8 % and a virological response in 81.3 % of patients infected with non-3rd HCV genotype and in 2 out of 3 people in whom the 3a genotype of the virus was detected. A sustained virological response was achieved in 75.0 and 66.7 % of patients with analyzed HCV genotypes. The modern scheme of using antiviral drugs of direct action (ADDA – sofosbuvir in combination with velpatasvir) provided better results – all patients, regardless of the genotype of the pathogen, received a biochemical and stable virological response. There were no significant changes in the clinical course of HIV infection in HIV/HCV co-infected patients during CHC treatment.

Conclusions. In the case of a combination of HIV infection with HCV, the effectiveness of the approved regimens was similar to that of patients with HCV mono-infection: sustained virological response (SVR) when using triple interferon-containing therapy was achieved in 66.7 % of patients, regardless of HCV genotype, and in all HIV-infected, who received the tested combination of ADDA. At the same time, the interferon-free scheme is more attractive not only in view of slightly higher efficiency, but also in connection with the absence of almost constant adverse events during triple therapy.

A comparative analysis of the results of this study with the results of CHC therapy in international protocols showed that the frequency of SVT in our patients is comparable to similar studies PROTON Study, FISSION Study, ASTRAL-1, ASTRAL-3, ASTRAL-5 regarding CHC therapy, as well as HIV/HCV-coinfections.

Treatment of CHC in HIV-infected patients should be started as early as possible, after establishing the diagnosis of chronic hepatitis, until there is no deep fibrosis and clinical signs of liver cirrhosis and patients do not need antiretroviral therapy. In this case, the probability of achieving SVR in HIV/HCV co-infection approaches the results of therapy for patients only on CHC.