A Cohort of Spanish Coinfected HIV/Hepatitis C Virus (HCV) Prisoners Treated With Direct-Acting Antiviral Agents (DAAs)

Abstract

Background. Highly curative therapies with DAAs should greatly enhance HCV treatment in prison because prevention benefits, so several guidelines recommend prioritizing treatment for inmates regardless of fibrosis stage. In Spain, the prevalence of HCV infection in prisoners achieved 20% in 2014; 26.8% of them were coinfected with HIV. Treating HIV/HCV-coinfected patients can be a challenge due to their special complexity. To our knowledge, few data have been published about DAA treatment on HIV/HCV-coinfected inmates. Our aim was to describe the preliminary outcome of a cohort of Spanish coinfected prisoners treated with DAAs. Methods. Prospective data collection of HIV/HCV-coinfected patients treated with DAAs in a penitentiary unit of a hospital (access to therapy was limited to available drugs, so we had to prioritize by liver function, fibrosis, and extrahepatic disease). Results. Since February 2015, 47 (12.7% females) coinfected with undetectable HIV load started treatment with DAAs (32 treatment naïve and 15 IFN-RBV pretreated). Mean age was 45.7 years (range 30-57 years). A big proportion (75.6%) were cirrhotic, 26/36 with >20 kPa FibroScan, 2 have already suffered liver decompensation, and 7 (14.8%) had esophageal varices. Genotype (GT) distribution was 21 GT1a (44.7%), 5 GT1b (10.6%) 1 GT2 (2%), 13 GT3 (27.6%), and 7 GT4 (14.9%). Proposed length of treatment was 12 weeks for 33 patients (70.2%) and 24 weeks for 14. All of them received SOF, 33/47 with LED in a STR (70%), 12 with SMV (25.5%) and only one with DTV. RBV was added in 39 (83%). On 113 May 2016, 38/47 patients had completed treatment without significant adverse event, but 2/38 died after the end of treatment (1 with acute portal thrombosis and 1 with no determined cause of sudden death). Virologic response rate at the end was 100%, and sustained virologic response at 12 weeks was 93.9 % (31/33). Two failures were detected with SOF + LED + RBV (1 GT1a and 1 GT1b). Only 1 abandoned treatment, in the sixth week; no more gave up the clinical follow-up despite prison release. After sustained virologic response at 24 weeks, a patient presented another acute portal thrombosis. Pending sustained virologic response at 12 week results will be updated at the Congress. Conclusion. Coinfected inmates show a high level of adherence and good tolerance to DAAs, achieving high cure HCV rates, but access to treatment can be too late for some of them. Public health should eliminate the barriers to access to treat HIV/HCV in the prison setting.