Background:
Highly Active Antiretroviral treatment (ART) with Direct-acting antiviral agents (DAAs) has demonstrated high efficacy and favorable safety profile in HIV/HCV co-infected individuals with HIV viral suppression and stable immune status. However there is great need in rapid initiation of ART and anti-HCV treatment regardless of HIV viral suppression status and CD4 T cell count as a simplified treatment strategy-To ‘Simultaneous Start’ treatment for both HIV and HCV.
Methods:
We conducted a retrospective, single-center study in Southwest China from May 2021 to August 2023. The study aimed to evaluate effectiveness and safety of immediate initiation or switch to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) with sofosbuvir/velpatasvir (SOF/VEL) administered once daily respectively in PWH(people with HIV) with recent acquired HCV. The primary endpoints were HIV and HCV viral suppression rate, defined as HIV RNA <20 cp/mL at 12 weeks and HCV RNA <15 IU/mL at 24 weeks after the end of HCV-treatment (SVR24).
Results:
Of the 128 patients enrolled, mean age of 36 years (31-39, IQR), 77% male (n=99). 52 were ART naive (TN), 76 were ART experienced (TE). The baseline characteristics were summarized in Table 1. All patients achieved HIV RNA suppression at 12 weeks and 36 weeks, 98.4% (126/128) patients achieved HCV SVR24. Among individuals with baseline CD4 T cell count < 200 cells/mm³ (n=32, 25%) , all achieved SVR 24. And 98% (94/96) of those with baseline CD4 cell count > 200 cells/mm³ (n=96, 75%) achieved SVR 24. The two patients who did not achieve SVR24 were PWID(people who inject drugs) infected with HCV genotype 3, had cirrhosis and poor adherence. Nine HBV/HCV/HIV co-infected patients maintained or achieved HBV DNA undetectable at 12 weeks and 36 weeks of treatment. No patient discontinued treatment due to adverse events.
Conclusions:
Immediate initiation or switch to BIC/FTC/TAF with SOF/VEL treatment provided high HIV and HCV suppression rate with a favorable safety profile. The study suggests that HCV treatment can start immediately without waiting for the CD4 T cell count to exceed 200 cells/mm³ in HIV/HCV co-infected individuals. This simplified ‘Simultaneous Start’ treatment may be a feasible and easy treatment strategy for HIV/HCV co-infected individuals.
