Dramatic Advances at CROI for HCV Treatment: Telaprevir, Boceprevir, Faldaprevir, Sofosbuvir, ABT-450, ABT-267, ABT-333 and Ledipasvir
This is a very exciting time for HCV coinfection.
While both telaprevir and boceprevir plus pegIFN and ribavirin continue to be standard of care and dramatically improve response rates in genotype 1 infection, treatment involves complex daily regimens, careful management of interactions with ARVs and other medications and side effects are difficult.
Although ribavirin is likely to continue to be needed with other oral HCV drugs that are furthest in the pipeline, treatment may be able to be shortened to 12 weeks with some combinations. These are generally once-daily drugs with fewer side effects, in all-oral combinations with very high rates of viral efficacy.
While results look impressive and encouraging these were generally interim analyses at early time points, and that patients with decompensated cirrhosis were not included.
Close monitoring is needed to determine the risks of deferring treatment for patients with the lowest risk for liver decompensation.
Unless stated otherwise, references are to the Programme and Abstracts of the 20th Conference on Retroviruses and Opportunistic Infections (CROI), 3-6 March 2013, Atlanta.
- Cotte L et al. High early virological response with telaprevir-pegylated-interferon-ribavirin in treatment-experienced hepatitis C virus genotype 1/HIV co-infected patients: ANRS HC26 TelapreVIH study. 20th CROI, 2013. Oral abstract 36.
- Poizot-Martin I et al. ANRS-HC27 BocepreVIH interim analysis: high early virologic response with boceprevir + pegylated interferon + ribivirin in hepatitis C virus/HIV co-infected patients with previous failure to pegylated interferon + ribivirin. 20th CROI, 2013. Oral abstract 37.
- Dieterich D et al. STARTVerso 4: high rates of early virologic response in hepatitis C virus genotype 1/HIV co-infected patients treated with faldaprevir + pegylated interferon and ribavirin. 20th CROI, 2013. Late breaker oral abstract 40LB.
- Dieterich D et al. Simeprevir with pegylated interferon/ribavirin in patients co-infected with chronic hepatitis C virus and HIV-1: week-24 interim analysis of the TMC435-C212 study. 20th CROI, 2013. Late breaker oral abstract 154LB.
- Lawitz E et al. Suppression of viral load through 4 weeks post-treatment results of a once-daily regimen of simeprevir + sofosbuvir with or without ribavirin in hepatitis C virus GT 1 null responders. 20th CROI, 2013. Late breaker oral abstract 155LB.
- Fierer D et al. Telaprevir for acute hepatitis C virus in HIV+ men both shortens treatment and improves outcome. 20th CROI, 2013. Late breaker oral abstract 156LB.
- Hammond K et al. Increased plasma and intracellular ribavirin concentrations associated with telaprevir use. 20th CROI, 2013. Oral abstract 34.
- Rhee E et al. Absence of a significant pharmacokinetic interaction between the hepatitis C virus protease inhibitor boceprevir and HIV-1 NNRTI rilpivirine. 20th CROI, 2013. Poster abstract 537.
- Sabo J et al. Pharmacokinetic interactions of darunavir/ritonavir, efavirenz, and tenofovir with the hepatitis C virus protease inhibitor faldaprevir in healthy volunteers. 20th CROI, 2013. Oral abstract 35.
- Liverpool University Drug Interractions website.
- Osinusi A et al. High efficacy of sofosbuvir with weight-based ribavirin for 24 weeks in difficult-to-treat patients. 20th CROI, 2013. Oral late breaker abstract 157LB.
- Lawitz E et al. 12 weeks of ABT-450/ritonavir, non-nucleoside inhibitor and ribavirin achieved SVR24 in >90% of treatment-naive hepatitis C virus GT1 patients and 47% of prior non-responders. 20th CROI, 2013. Oral abstract 38.
- Lawitz E et al. Suppression of viral load through 4 weeks post-treatment results of a once-daily regimen of simeprevir + sofosbuvir with or without ribavirin in hepatitis C virus GT 1 null responders. 20th CROI, 2013. Oral late breaker abstract 155LB.
- Gane E et al. ELECTRON: 100% suppression of viral load through 4 weeks' post-treatment for sofosbuvir + ledipasvir (GS-5885) + ribavirin for 12 weeks in treatment-naive and -experienced hepatitis C virus GT 1 patients. Oral late breaker abstract 41LB.
- Macias J et al. Risk of decompensation of cirrhosis among HIV/Hepatitis C virus Co-infected individuals with advanced fibrosis: implications for the timing of therapy against hepatitis C virus. 20th CROI, 2013. Poster abstract 727.
- Bhagani S. CROI 2013: hepatitis/TB and opportunistic infections and malignancies. BHIVA feedback workshop.
Links to other websites are current at date of posting but not maintained.
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