J Korean Med Sci.  2021 Nov;36(46):e308. 10.3346/jkms.2021.36.e308.

Clinical Characteristics and Treatment Outcomes of Patients with Hepatitis C Virus and Human Immunodeficiency Virus Coinfection: Experience at a Single Center in Korea

Affiliations
  • 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Medical Center, Seoul, Korea
  • 2Division of Infectious Diseases, Department of Internal Medicine, National Medical Center, Seoul, Korea

Abstract

Background
Because of the very low incidence of human immunodeficiency virus (HIV) coinfection in Korea, data on hepatitis C virus (HCV)/HIV coinfection are limited. This study aimed to investigate the clinical characteristics and treatment outcomes of patients with HCV/HIV coinfection in Korea.
Methods
We performed a retrospective cohort study of all HCV-monoinfected and HCV/ HIV-coinfected patients treated with antivirals at National Medical Center in Seoul, Korea, between January 2009 and March 2020.
Results
We enrolled 220 HCV-monoinfected and 23 HCV/HIV-coinfected patients treated with antivirals. The HCV/HIV-coinfected patients were younger (HCV vs. HCV/HIV: 57.3 ± 11.3 vs. 40.7 ± 10.1 years, P < 0.001) and had a higher proportion of men (HCV vs. HCV/ HIV: 54.5% [n = 120] vs. 91.3% [n = 21], P < 0.001) than the HCV-monoinfected patients. Genotype 1b and 2 were most common in both HCV monoinfection and HCV/HIV coinfection groups. HCV-monoinfected patients had a higher incidence of genotype 1b and 2 than HCV/HIV-coinfected patients (HCV vs. HCV/HIV: 95.4% [n = 210] vs. 73.9% [n = 17], P < 0.001), while the HCV/HIV-coinfected patients had genotype 1a (HCV vs. HCV/HIV: 1.8% [n = 4] vs. 21.7% [n = 5], P < 0.001). The fibrosis-4 index was significantly lower in the HCV/ HIV-coinfected patients than in the HCV-monoinfected patients (HCV vs. HCV/HIV: 3.81 ± 3.38 vs. 1.66 ± 1.10, P < 0.001). Among the direct-acting antivirals (DAA)-treated patients, the sustained viral response (SVR) rate did not differ significantly between both groups (HCV vs.HCV/HIV: 94.9% [93/99] vs. 90.9% [10/11], P = 0.480).
Conclusion
In Korea, the HCV/HIV-coinfected patients who received antiviral treatment were younger, had higher proportion of men and incidence of genotype 1a, and had less advanced fibrosis than the HCV-monoinfected patients. In actual clinical settings, HCV/HIV-coinfected patients show excellent SVR to DAA treatment, similar to HCVmonoinfected patients.

Keyword

Hepatitis C Virus; Human Immunodeficiency Virus; Direct-Acting Antivirals

Figure

  • Fig. 1 Flow chart of patient enrollment.HCV = hepatitis C virus, Ab = antibody, HIV = human immunodeficiency virus, GT = genotype, HBs Ag = hepatitis B surface antigen.

  • Fig. 2 Antiviral treatment regimens according to the study groups.HCV = hepatitis C virus, HIV = human immunodeficiency virus, PEG-INF = pegylated interferon-α, RBV = ribavirin, DCV = daclatasvir, ASV = asunaprevir, SOF = sofosbuvir, LDV = ledipasvir, GZR/EBR = grazoprevir/elbasvir, OBV/PTV/r = ombitasvir/paritaprevir/ritonavir, DSV = dasabuvir, GLE/PIB = glecaprevir/pibrentasvir.

  • Fig. 3 Treatment efficacy of pegylated interferon-based therapy.HCV = hepatitis C virus, HIV = human immunodeficiency virus, SVR = sustained viral response, ITT = intent-to-treat, mITT = modified intent-to-treat.

  • Fig. 4 Treatment efficacy of direct-acting antiviral agent therapy.HCV = hepatitis C virus, HIV = human immunodeficiency virus, SVR = sustained viral response, ITT = intent-to-treat, mITT = modified intent-to-treat.


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