SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Réexamen
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2018/07  
 
  2018 Jul;68(1):32-47.  
  doi: 10.1002/hep.29814.  
 
  All-oral direct-acting antiviral therapy against hepatitis C virus (HCV) in human immunodeficiency virus/HCV-coinfected subjects in real-world practice: Madrid coinfection registry findings.  
 
  Berenguer J, Gil-Martin Á, Jarrin I, Moreno A, Dominguez L, Montes M, Aldámiz-Echevarría T, Téllez MJ, Santos I, Benitez L, Sanz J, Ryan P, Gaspar G, Alvarez B, Losa JE, Torres-Perea R, Barros C, Martin JVS, Arponen S, de Guzmán MT, Monsalvo R, Vegas A, Garcia-Benayas MT, Serrano R, Gotuzzo L, Menendez MA, Belda LM, Malmierca E, Calvo MJ, Cruz-Martos E, González-García JJ  
  https://www.ncbi.nlm.nih.gov/pubmed/29377274  
 
 

Abstract
 

We evaluated treatment outcomes in a prospective registry of human immunodeficiency virus/hepatitis C virus (HCV)-coinfected patients treated with interferon-free direct-acting antiviral agent-based therapy in hospitals from the region of Madrid between November 2014 and August 2016. We assessed sustained viral response at 12 weeks after completion of treatment and used multivariable logistic regression to identify predictors of treatment failure. We evaluated 2,369 patients, of whom 59.5% did not have cirrhosis, 33.9% had compensated cirrhosis, and 6.6% had decompensated cirrhosis. The predominant HCV genotypes were 1a (40.9%), 4 (22.4%), 1b (15.1%), and 3 (15.0%). Treatment regimens included sofosbuvir (SOF)/ledipasvir (61.9%), SOF plus daclatasvir (14.6%), dasabuvir plus ombitasvir/paritaprevir/ritonavir (13.2%), and other regimens (10.3%). Ribavirin was used in 30.6% of patients. Less than 1% of patients discontinued therapy owing to adverse events. The frequency of sustained viral response by intention-to-treat analysis was 92.0% (95% confidence interval, 90.9%-93.1%) overall, 93.8% (92.4%-95.0%) for no cirrhosis, 91.0% (88.8%-92.9%) for compensated cirrhosis, and 80.8% (73.7%-86.6%) for decompensated cirrhosis. The factors associated with treatment failure were male sex (adjusted odds ratio, 1.75; 95% confidence interval, 1.14-2.69), Centers for Diseases Control and Prevention category C (adjusted odds ratio, 1.65; 95% confidence interval, 1.12-2.41), a baseline cluster of differentiation 4-positive (CD4+) T-cell count <200/mm3 (adjusted odds ratio, 2.30; 95% confidence interval, 1.35-3.92), an HCV RNA load ≥800,000 IU/mL (adjusted odds ratio, 1.63; 95% confidence interval, 1.14-2.36), compensated cirrhosis (adjusted odds ratio, 1.35; 95% confidence interval, 0.96-1.89), decompensated cirrhosis (adjusted odds ratio, 2.92; 95% confidence interval, 1.76-4.87), and the use of SOF plus simeprevir, SOF plus ribavirin, and simeprevir plus daclatasvir.

CONCLUSION:

In this large real-world study, direct-acting antiviral agent-based therapy was safe and highly effective in coinfected patients; predictors of failure included gender, human immunodeficiency virus-related immunosuppression, HCV RNA load, severity of liver disease, and the use of suboptimal direct-acting antiviral agent-based regimens. (Hepatology 2018;68:32-47).

 
Question posée
 
Devenir des patients co-infectés VIH-VHC traités par anti-viraux directs dans une large cohorte espagnole majoritairement non cirrhotiques et surtout traités par sofosbuvir.
 
Question posée
 
La SVR est de 92% avec une réponse de 81% en cas de cirrhose décompensée. Les facteurs associés à l’échec du traitement sont : le genre masculin, l’immunosuppression liée au VIH, la charge virale VHC, la sévérité de l’atteinte hépatique et la dose sub-optimale d’anti-viraux directs.
 
Commentaires

Il faut peut-être attendre une bonne immunosuppression VIH en l’absence de maladie sévère du foie pour traiter les patient co-infectés VIH-VHC. Un traitement plus court par anti-viraux directs n’est probablement pas recommandé.

 
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