Direct-acting antivirals are effective and safe in HCV/HIV-coinfected liver transplant recipients who experience recurrence of hepatitis C: A prospective nationwide cohort study

Direct-acting antivirals have proved to be highly efficacious and safe in monoinfected liver transplant (LT) recipients who experience recurrence of hepatitis C virus (HCV) infection. However, there is a lack of data on effectiveness and tolerability of these regimens in HCV/HIV-coinfected patients who experience recurrence of HCV infection after LT. In this prospective, multicenter cohort study, the outcomes of 47 HCV/HIV-coinfected LT patients who received DAA therapy (with or without ribavirin [RBV]) were compared with those of a matched cohort of 148 HCV-monoinfected LT recipients who received similar treatment. Baseline characteristics were similar in both groups. HCV/HIV-coinfected patients had a median (IQR) CD4 T-cell count of 366 (256-467) cells/mu L. HIV-RNA was <50 copies/mL in 96% of patients. The DAA regimens administered were SOF+LDVRBV (34%), SOF+SMV +/- RBV (31%), SOF+DCV +/- RBV (27%), SMV+DCV +/- RBV (5%), and 3D (3%), with no differences between the groups. Treatment was well tolerated in both groups. Rates of SVR (negative serum HCV-RNA at 12weeks after the end of treatment) were high and similar for coinfected and monoinfected patients (95% and 94%, respectively; P=.239). Albeit not significant, a trend toward lower SVR rates among patients with advanced fibrosis (P=.093) and genotype 4 (P=.088) was observed. In conclusion, interferon-free regimens with DAAs for post-LT recurrence of HCV infection in HIV-infected individuals were highly effective and well tolerated, with results comparable to those of HCV-monoinfected patients. Direct-acting antivirals against HCV offer a very high and similar efficacy and safety in HIV-positive and HIV-negative liver transplant recipients.