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Isakov V, Hedskog C, Wertheim JO, Hostager RE, Parhy B, Schneider ADB, Suri V, Mo H, Geivandova N, Morozov V, Bessonova E, Gankina N, Zhdanov K, Abdurakhmanov D, Svarovskaia E. Prevalence of resistance-associated substitutions and phylogenetic analysis of hepatitis C virus infection in Russia. Int J Infect Dis 2021; 113:36-42. [PMID: 34560266 DOI: 10.1016/j.ijid.2021.09.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES Due to limited hepatitis C virus (HCV) sequence availability from patients in Russia, the relationship between subtypes and baseline resistance-associated substitutions (RAS) to direct antiretroviral treatment outcome is not fully understood. METHODS Deep sequencing of HCV NS3, NS5A, and NS5B sequences was performed on plasma HCV samples from 412 direct-acting antiviral (DAA)-naïve patients from Russia. Phylogenetic analysis was performed to investigate sequence similarities between HCV strains from Russia, Asia, Europe, and North America. Pretreatment HCV RAS was assessed with a 15% cutoff. RESULTS HCV genotype GT1b and GT3a sequences in Russia were related to strains in Europe and Asia. The prevalence of GT1a and GT2a was low in Russia. In GT1b, the prevalence of NS5A Y93H was lower in Russia (6%) compared with Asia (15%). The prevalence of NS5B L159F was similar between Russia and Europe (26-39%). GT3a RAS prevalence was similar between Russia and Asia, Europe, and North America. The 2k/1b recombinant strain in Russia was related to strains from Europe. A higher prevalence of the NS5A RAS L31M (10%) was observed in 2k/1b sequences compared to GT1b (1-6%). CONCLUSIONS The prevalence of RASs and the phylogenetic analysis showed similarities in HCV strains between Russia, Europe, and North America. This information may be useful for HCV regimens in Russia.
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Affiliation(s)
- Vasily Isakov
- Federal Research Center of Nutrition, Biotechnology and Food Safety, Moscow, Russia
| | | | - Joel O Wertheim
- University of California San Diego, San Diego, California, USA
| | | | - Bandita Parhy
- Gilead Sciences, Inc., Foster City, California, USA.
| | | | - Vithika Suri
- Gilead Sciences, Inc., Foster City, California, USA
| | - Hongmei Mo
- Gilead Sciences, Inc., Foster City, California, USA
| | | | | | - Elena Bessonova
- Sverdlovsk Regional Clinical Hospital, Yekaterinburg, Russia
| | - Natalya Gankina
- Krasnoyarsk Regional Center of Prevention and Control of AIDS, Krasnoyarsk, Russia
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Zhdanov K, Isakov V, Burnevich E, Kizhlo S, Bakulin I, Pokrovsky V, Liang L, Hwang P, Talwani R, Haber BA, Robertson MN. Elbasvir/Grazoprevir for HCV Infection in Russia: A Randomized Trial. Hepat Med 2020; 12:61-68. [PMID: 32368162 PMCID: PMC7183329 DOI: 10.2147/hmer.s241418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/02/2020] [Indexed: 01/03/2023] Open
Abstract
Purpose Hepatitis C virus (HCV) infection is a major healthcare concern in Russia, where almost 5 million individuals are viremic. Elbasvir/grazoprevir is a fixed-dose combination therapy for the treatment of HCV genotype 1 and genotype 4 infection. The present analysis aimed to assess the safety and efficacy of elbasvir/grazoprevir in individuals with HCV infection enrolled at Russian study sites in the C-CORAL study. Patients and Methods C-CORAL (Protocol PN-5172-067; NCT02251990) was a Phase 3, placebo-controlled, double-blind study conducted throughout Asia and Russia. Treatment-naive participants with chronic HCV infection were randomly assigned to receive immediate or deferred treatment with elbasvir 50 mg/grazoprevir 100 mg once daily for 12 weeks. Participants in the immediate-treatment group received elbasvir/grazoprevir for 12 weeks, and those in the deferred-treatment group received placebo for 12 weeks, followed by open-label elbasvir/grazoprevir for 12 weeks. The primary endpoint was sustained virologic response at 12 weeks after completion of therapy (SVR12). Results One hundred and nineteen Russian participants were randomized (immediate-treatment group, n=88; deferred-treatment group, n=31). Most participants were white (99%) with HCV genotype 1b infection (97%) and mild-to-moderate (F0–F2) fibrosis (70%). SVR12 was achieved by 98.9% participants in the immediate-treatment group and by 100% of those receiving deferred elbasvir/grazoprevir in the deferred-treatment group. One participant relapsed with nonstructural protein 5A (NS5A) L28M and Y93H resistance-associated substitutions at baseline and at time of failure. Drug-related adverse events were reported by 19% of participants receiving elbasvir/grazoprevir in the immediate-treatment group and by 16% of those receiving placebo in the deferred-treatment group. No serious adverse event or deaths occurred, and no participant discontinued treatment owing to an adverse event. Conclusion Elbasvir/grazoprevir for 12 weeks was highly effective in treatment-naive Russian individuals with HCV genotype 1b infection.
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Affiliation(s)
| | - Vasily Isakov
- Department of Gastroenterology & Hepatology, Federal Research Centre of Nutrition, Biotechnology and Food Safety, Moscow, Russia
| | - Eduard Burnevich
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Svetlana Kizhlo
- City Center for AIDS and Infectious Diseases Treatment and Prophylaxis, St. Petersburg, Russia
| | - Igor Bakulin
- I.I. Mechnikov North-Western State Medical University of the Ministry of Health of the Russian Federation, St. Petersburg, Russia
| | - Vadim Pokrovsky
- Department of AIDS, Central Research Institute of Epidemiology, Moscow, Russia
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Banga J, Nizami S, Slim J, Nagarakanti S, Portilla M, Swaminathan S. Hepatitis C virus treatment response to ledipasvir/sofosbuvir among patients coinfected with HIV and HCV: Real world data in a black population. Medicine (Baltimore) 2020; 99:e19140. [PMID: 32176039 PMCID: PMC7440318 DOI: 10.1097/md.0000000000019140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Treatment of hepatitis C virus (HCV) infection for patients with human immunodeficiency virus (HIV) has improved with direct acting antivirals. However, outcomes among Black persons treated with ledipasvir/sofosbuvir (LDV/SOF) may be inferior to non-Blacks. We assessed responses to LDV/SOF in a cohort of Black HIV/HCV coinfected persons.Retrospective chart reviews were conducted for Black, genotype 1 (GT1), HIV/HCV coinfected patients treated with LDV/SOF at 3 hospitals in Newark, NJ between January 2014 and July 2016. Data collected included demographics, HCV treatment history, treatment duration, and response.One hundred seventeen HIV/HCV coinfected Black patients started treatment with LDV/SOF but 5 had no follow-up data and 5 prematurely discontinued treatment (1 due to side effects). We included 107 HIV/HCV coinfected patients who completed LDV/SOF at all 3 sites. The study population was 65% male, median age 58 years, 26% had cirrhosis, and 78% had GT1a. Thirty-one percent were treatment experienced but none with prior NS5a treatment. At baseline, median CD4 count was 680 cells/mm, HIV viral load (VL) was <40 copies/mL in 94% and median HCV VL was 2,257,403 IU/mL. Twenty-nine percent of patients changed antiretroviral treatment before LDV/SOF treatment due to drug interactions. Six, 89, and 12 patients completed 8, 12, and 24 weeks of LDV/SOF, respectively. Overall sustained virologic response rate was 93% with 7 relapses.In this real-world cohort of Black, GT1, HIV/HCV coinfected patients, LDV/SOF had high sustained virologic response 12 weeks post completion of treatment rate of 93%. This data supports the overall high efficacy of LDV/SOF in a historically difficult-to-treat patient population.
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Smolders EJ, Jansen AME, Ter Horst PGJ, Rockstroh J, Back DJ, Burger DM. Viral Hepatitis C Therapy: Pharmacokinetic and Pharmacodynamic Considerations: A 2019 Update. Clin Pharmacokinet 2019; 58:1237-1263. [PMID: 31114957 PMCID: PMC6768915 DOI: 10.1007/s40262-019-00774-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
It has been estimated by the World Health Organization (WHO) that over 71 million people were infected with the hepatitis C virus (HCV) in 2015. Since then, a number of highly effective direct-acting antiviral (DAA) regimens have been licensed for the treatment of chronic HCV infection: sofosbuvir/daclatasvir, sofosbuvir/ledipasvir, elbasvir/grazoprevir, sofosbuvir/velpatasvir, glecaprevir/pibrentasvir, and sofosbuvir/velpatasvir/voxilaprevir. With these treatment regimens, almost all chronic HCV-infected patients, even including prior DAA failures, can be treated effectively and safely. It is therefore likely that further development of DAAs will be limited. In this descriptive review we provide an overview of the clinical pharmacokinetic characteristics of currently available DAAs by describing their absorption, distribution, metabolism, and excretion. Potential drug-drug interactions with the DAAs are briefly discussed. Furthermore, we summarize what is known about the pharmacodynamics of the DAAs in terms of efficacy and safety. We briefly discuss the relationship between the pharmacokinetics of the DAAs and efficacy or toxicity in special populations, such as hard to cure patients and patients with liver cirrhosis, liver transplantation, renal impairment, hepatitis B virus or HIV co-infection, bleeding disorders, and children. The aim of this overview is to educate/update prescribers and pharmacists so that they are able to safely and effectively treat HCV-infected patients even in the presence of underlying co-infections or co-morbidities.
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Affiliation(s)
- Elise J Smolders
- Department of Pharmacy, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
- Department of Pharmacy, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Anouk M E Jansen
- Department of Pharmacy, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Peter G J Ter Horst
- Department of Pharmacy, Isala Hospital, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - Jürgen Rockstroh
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - David J Back
- Department of Clinical and Molecular Pharmacology, University of Liverpool, Liverpool, UK
| | - David M Burger
- Department of Pharmacy, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Jones CR, Flower BF, Barber E, Simmons B, Cooke GS. Treatment optimisation for hepatitis C in the era of combination direct-acting antiviral therapy: a systematic review and meta-analysis. Wellcome Open Res 2019; 4:132. [PMID: 31754636 PMCID: PMC6854875 DOI: 10.12688/wellcomeopenres.15411.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Prior to direct-acting antiviral (DAA) therapy, personalised medicine played an important role in the treatment of hepatitis C virus (HCV). Whilst simplified treatment strategies are central to treatment scale-up, some patients will benefit from treatment optimisation. This systematic review and meta-analysis explores treatment optimisation strategies in the DAA era. Methods: We systematically searched Medline, Embase, and Web of Science for studies that adopted a stratified or personalised strategy using a licensed combination DAA regimen, alone or with additional agents. We performed a thematic analysis to classify optimisation strategies and a meta-analysis of sustained virologic response rates (SVR), exploring heterogeneity with subgroup analyses and meta-regression. Results: We included 64 studies (9450 participants). Thematic analysis found evidence of three approaches: duration, combination, and/or dose optimisation. We separated strategies into those aiming to maintain SVR in the absence of predictors of failure, and those aiming to improve SVR in the presence of predictors of failure. Shortened duration regimens achieve pooled SVR rates of 94.2% (92.3-95.9%) for 8 weeks, 81.1% (75.1-86.6%) for 6 weeks, and 63.1% (39.9-83.7%) for ≤4 weeks. Personalised strategies (100% vs 87.6%; p<0.001) and therapy shortened according to ≥3 host/viral factors (92.9% vs 81.4% or 87.2% for 1 or 2 host/viral factors, respectively; p=0.008) offer higher SVR rates when shortening therapy. Hard-to-treat HCV genotype 3 patients suffer lower SVR rates despite treatment optimisation (92.6% vs 98.2%; p=0.001). Conclusions: Treatment optimisation for individuals with multiple predictors of treatment failure can offer high SVR rates. More evidence is needed to identify with confidence those individuals in whom SVR can be achieved with shortened duration treatment.
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Affiliation(s)
| | - Barnaby F. Flower
- Department of Infectious Disease, Imperial College London, London, W2 1NY, UK
- Oxford University Clinical Research Unit, Centre for Tropical Medicine, Ho Chi Minh City, Vietnam
| | - Ella Barber
- Department of Infectious Disease, Imperial College London, London, W2 1NY, UK
| | - Bryony Simmons
- Department of Infectious Disease, Imperial College London, London, W2 1NY, UK
| | - Graham S. Cooke
- Department of Infectious Disease, Imperial College London, London, W2 1NY, UK
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Chromy D, Mandorfer M, Bucsics T, Schwabl P, Scheiner B, Schmidbauer C, Aichelburg MC, Ferenci P, Trauner M, Peck-Radosavljevic M, Reiberger T. High efficacy of interferon-free therapy for acute hepatitis C in HIV-positive patients. United European Gastroenterol J 2019; 7:507-516. [PMID: 31065368 PMCID: PMC6488804 DOI: 10.1177/2050640619835394] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 01/02/2019] [Indexed: 12/19/2022] Open
Abstract
Background The treatment of acute hepatitis C (AHC) with direct-acting antiviral agents (DAAs) is considered a cornerstone of hepatitis C virus (HCV) elimination strategies, especially in human immunodeficiency virus (HIV)-infected individuals at high risk of onward transmission. Objective Optimal treatment regimens and duration for AHC in HIV-coinfected patients remain to be established. Thus, we aimed to evaluate the efficacy and safety of DAA treatment regimens in the setting of AHC. Methods All HIV-positive patients with a diagnosis of AHC according to the European AIDS Treatment Network (NEAT) consensus attending our clinic after 2014 were included. DAA treatment regimens and duration were based on current recommendations for chronic hepatitis C (CHC) at treatment initiation. Results Thirty-eight HIV/AHC patients (median age 42.0 years), mostly men who have sex with men (92%), were started on interferon-free regimens. HCV-genotype (GT) was predominately GT-1a (65%). The following DAA regimens were prescribed: ombitasvir/paritaprevir/ritonavir/dasabuvir (42%; 16/38), glecaprevir/pibrentasvir (29%; 11/38), sofosbuvir/ledipasvir (13%; 5/38), ombitasvir/paritaprevir/ritonavir (5%; 2/38), grazoprevir/elbasvir (5%; 2/38) and sofosbuvir/velpatasvir (5%; 2/38). All HIV/AHC patients achieved sustained virologic response 12 weeks after end of treatment (SVR12) (100%; 38/38). DAA-related adverse events were rare. Conclusion Interferon-free DAA regimens (including 34% pan-genotypic regimens) yielded 100% SVR12 in HIV/AHC individuals if treatment durations similar to CHC are applied.
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Affiliation(s)
- David Chromy
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
- Vienna HIV & Liver Study Group,
Vienna, Austria
| | - Mattias Mandorfer
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
- Vienna HIV & Liver Study Group,
Vienna, Austria
| | - Theresa Bucsics
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
- Vienna HIV & Liver Study Group,
Vienna, Austria
| | - Philipp Schwabl
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
- Vienna HIV & Liver Study Group,
Vienna, Austria
| | - Bernhard Scheiner
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
- Vienna HIV & Liver Study Group,
Vienna, Austria
| | - Caroline Schmidbauer
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
- Vienna HIV & Liver Study Group,
Vienna, Austria
- Department of Internal Medicine IV,
Wilhelminenspital, Wiener Krankenanstaltenverbund (KAV) der Stadt Wien, Vienna,
Austria
| | - MC Aichelburg
- Vienna HIV & Liver Study Group,
Vienna, Austria
- Division of Immunology, Allergy and
Infectious Diseases, Department of Dermatology, Medical University of Vienna,
Vienna, Austria
| | - Peter Ferenci
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
| | - Michael Trauner
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
| | - Markus Peck-Radosavljevic
- Vienna HIV & Liver Study Group,
Vienna, Austria
- Department of Internal Medicine and
Gastroenterology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and
Hepatology, Department of Internal Medicine III, Medical University of Vienna,
Vienna, Austria
- Vienna HIV & Liver Study Group,
Vienna, Austria
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