Early emergence of opportunistic infections after starting direct‐acting antiviral drugs in HIV/HCV‐coinfected patients

Abstract

Varicella‐zoster virus and hepatitis B virus reactivations have been reported after starting interferon‐free direct‐acting antiviral agent (DAA ) combinations. HIV /HCV ‐coinfected patients could be a high‐risk group for the reactivation of latent infections. Because of these, we report the occurrence of severe infections after starting DAA regimens in HIV /HCV ‐coinfected patients. Individuals included in the HEPAVIR ‐DAA (NCT 02057003) cohort were selected if they had received all‐oral DAA combinations. A retrospective review of clinical events registered between the start of DAA s and 12 months after SVR 12 was carried out. Overall, 38 (4.5%) of 848 patients presented infections. The incidence (95% confidence interval) of infections was 4.6 (3.3‐6.3) cases per 100 person‐years. The median (Q1‐Q3) time to the infection since baseline was 23 (7.3‐33) weeks. Five (13%) of the patients with infections died; four of them had cirrhosis. The frequency of previous AIDS was 21 (54%) for patients with infections and 324 (40%) for those without infections (P = 0.084). The median (Q1‐Q3) nadir CD 4 cell count of individuals with and without infections was 75 (53‐178) and 144 (67‐255) cells/μL, respectively (P = 0.047). Immunodepression‐associated infections were observed in 9 (1.1%) patients. All of them had suppressed HIV replication with antiretroviral therapy. In conclusion, severe infections are relatively common among HIV /HCV ‐coinfected patients receiving all‐oral DAA combinations. Some unusual reactivations of latent infections in patients with suppressed HIV replication seem to be temporally linked with DAA use.