Efficacy and costs of Direct Acting Antivirals (DAAS) for the treatment of HCV Iinfection amnog HCV-monoinfected and HIV/HCV co-infected patients in real-life setting

BACKGROUND Although several studies analyzing the effectiveness of DAAs have showed no differences between HCV-monoinfected and HIV/HCV-coinfected patients,data in real-life setting are still limited. PURPOSE To compare efficacy and costs of DAAs in HCV-monoinfected and HIV/HCV-coinfected subjects. METHODS A database of HCV-monoinfected and HIV/HCV-coinfected adults who started HCV therapy between January 2015 and July 2016 was created in order to collect the following data:sustained virological response to DAAs therapy at week 12(SVR12) and at week 24(SVR24) after treatment initiation, treatment regimen, and overall cost of anti-HCV regimens.Patients were treated as follows: sofosbuvir/ribavirin ± peg-INF (n=37), sofosbuvir/daclatasvir(n=72), sofosburiv/ledipasvir(n=68), sofosburiv/simeprevir(n=77), simeprevir/peg-interferon(n=13) or ombitasvir/paritaprevir/ritonavir/dasabuvir(n=14). Overall, ribavirin was used in combination with DAAs in 67% of patients. RESULTS The study enrolled 281 subjects(81% monoinfected and 19% co-infected), treated for 12(54% of monoinfected and 50% of co-infected) or 24 weeks(46% of monoinfected and 50% of co-infected). Two hundred and twenty nine patients had cirrhosis or high degree fibrosis (≥F3) at the beginning of DAAs (79% of HCV-monoinfected and 91% of HIV/HCV co-infected);other 23 subjects(all but one HCV-monoinfected) were treated after liver transplantation. Two hundreds and ten (93%) HCV-monoinfected patients completed the treatment; 96% achieved SVR12 and 97% reached SVR24. The most prescribed regimens were 12-week sofosburiv/simeprevir(27%) or sofosburiv/ledipasvir(17%), and 24-week sofosbuvir/daclatasvir(17%). The average cost of a complete HCV-treatment in monoinfected population was € 49.633 per patient. Among the 47 HIV/HCV-coinfected patients(87%) who completed the treatment, 94% achieved SVR12 and 96% obtained SVR24;12-week sofosburiv/simeprevir was prescribed to 24% of them, whereas the most frequent 24-week treatments were sofosburiv/daclatasvir and sofosburiv/ledipasvir(20% each). The average cost of a complete HCV-treatment in coinfected population was € 53.573 per patient. CONCLUSION This study confirms the high effectiveness of DAAs in the treatment of HCV infection in real life setting, both in HCV-monoinfected and HIV/HCV-coinfected patients. The average cost of single treatment was also similar between the two groups.