title: Predicted effect of direct acting antivirals in the current HIV-HCV-coinfected population in Spain.
abstract: BACKGROUND
  Direct acting antivirals (DAAs) against HCV are eagerly awaited for HIV-HCV-coinfected individuals. However, the activity of first generation drugs is limited to HCV genotype 1 and is lower in cirrhotics, subtype 1a infections, prior interferon (IFN)-α exposure or unfavourable IL28B alleles. Herein, we report the current profile of HIV-HCV-coinfected patients at our institution in an attempt to predict the effect of DAAs.
  
  
  METHODS
  All HIV-HCV-coinfected patients seen at our HIV outpatient clinic in 2011 were identified. Information on serum HCV RNA, HCV genotype/subtype, plasma HIV RNA, prior IFN-α experience, liver fibrosis staging and IL28B alleles was recorded.
  
  
  RESULTS
  A total of 424 HIV-HCV-coinfected patients were identified, of whom 174 (41%) were IFN-α-experienced. Mean serum HCV RNA was 6 log IU/ml. HCV genotype/subtype distribution was 166 (39.1%) G1a, 93 (22%) G1b, 85 (20%) G4, 49 (11.5%) G3 and 1 (<1%) G2, and 30 (7%) were unclassified. Of note, 56% of G1a were prior IFN-α-experienced patients. Overall, 37% had advanced liver fibrosis (Metavir score estimates F3-F4). Finally, 70% harboured unfavourable IL28B alleles.
  
  
  CONCLUSIONS
  The current profile of HIV-HCV-coinfected patients in Spain is dominated by particularly difficult-to-treat individuals, such as those infected with G1a or G4 (59%), advanced liver fibrosis (37%) and unfavourable IL28B alleles (70%). A wide use of prior anti-HCV therapy in our region most likely has resulted in hepatitis C cure of more IFN-α susceptible individuals, with accumulation of a more refractory treatment population. Thus, the use of DAAs in HIV-HCV-coinfected patients will require particular expertise and their benefit might be lower than expected.
authors.affiliation: Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Poveda
authors.forename: Eugenia
authors.initials: E
authors.lastname: Vispo
authors.forename: Pablo
authors.initials: P
authors.lastname: Barreiro
authors.forename: Carmen
authors.initials: C
authors.lastname: de Mendoza
authors.forename: Pablo
authors.initials: P
authors.lastname: Labarga
authors.forename: José Vicente
authors.initials: JV
authors.lastname: Fernández-Montero
authors.forename: Luz
authors.initials: L
authors.lastname: Martin-Carbonero
authors.forename: Vincent
authors.initials: V
authors.lastname: Soriano
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000494:pharmacology* / Q000627:therapeutic use; D060085:Coinfection / Q000188:drug therapy* / Q000821:virology; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000187:drug effects; D016174:Hepacivirus / Q000145:classification / Q000187:drug effects* / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D006801:Humans; D007372:Interferons; D007378:Interleukins / Q000235:genetics; D008103:Liver Cirrhosis / Q000188:drug therapy* / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D013030:Spain; D016896:Treatment Outcome; D000095022:Interferon Lambda
chemical_list: D000998:Antiviral Agents; D007372:Interferons; D007378:Interleukins; C000624353:interferon-lambda, human; D000095022:Interferon Lambda