Low risk of failing direct-acting antivirals in people with HIV/HCV from Sub-Saharan Africa or Southeastern Asia: a European cross-sectional study

Abstract Background Several studies have reported sub-optimal efficacy of direct-acting antivirals (DAA) to treat hepatitis C virus (HCV) subtypes endemic to Sub-Saharan Africa (SSA) and Southeastern Asia (SEA). The extent of this issue in individuals with HIV/HCV from SSA or SEA residing in Europe is unknown. Methods We retrospectively analyzed data from several prospective European cohorts of people living with HIV. We included individuals with HIV/HCV who originated from SSA or SEA, were treated with interferon-free DAA, and had an available HCV RNA result ≥12 weeks after end of treatment. The primary outcome was sustained virological response at least twelve weeks after end of treatment (SVR-12). Results Of the 3293 individuals with HIV/HCV treated with DAA and with available SVR-12 data, 142 were from SSA (n = 64) and SEA (n = 78). SVR-12 was achieved by 60 (94%, 95% CI 86-98%) individuals from SSA and 76 (97%, 95% CI 92-99%) from SEA. The genotypes of the six individuals failing DAA treatment were 2, 3a, 3 h, 4a, 4c, and 6j. For two of the four unsuccessfully treated individuals with available sequence data at treatment failure, NS5A resistance-associated substitutions were present (30R/93S in an individual with genotype 4c and 31 M in an individual with genotype 6j). Conclusions SVR-12 rates were high in individuals with HIV/HCV residing in Europe and originating from regions where intrinsically NS5A-resistant HCV strains are endemic. HCV elimination for this population in Europe will unlikely be hampered by sub-optimal DAA efficacy.