Early Emergence of Opportunistic Infections After Starting Direct-acting Antiviral Drugs in HIV/HCV-coinfected Patients

Juan Macías; Francisco Téllez; Antonio Rivero-Juárez; Rosario Palacios; Luis E. Morano; Dolores Merino; Antonio Collado; Lucio García-Fraile; Mohamed Omar; Juan A. Pineda; On behalf of the HEPAVIR, GEHEP and RIS-HEP07 study groups


J Viral Hepat. 2019;26(1):48-54. 

In This Article


Hepatitis C virus (HCV) clearance with treatment reduces the risk of death in human immunodeficiency virus (HIV)/HCV coinfection. Thus, liver events are largely prevented among HIV/HCV-coinfected patients with cirrhosis who achieve sustained virological response (SVR) to pegylated interferon plus ribavirin (PegIFN/RBV),[1] having only a residual risk for liver decompensation and hepatocellular carcinoma (HCC).1 In addition, it has been reported that SVR following PegIFN/RBV treatment among HIV- and HCV-coinfected patients may reduce the risk of some non-hepatic events.[2]

Sustained virological response rates to interferon-free direct-acting antiviral drug (DAA) combinations are higher than those obtained with older treatments.[3–10] For HIV/HCV-coinfected patients, high rates of SVR have also been reported.[7–13] However, it is not known whether some benefits of SVR to PegIFN/RBV on non-hepatic outcomes might be extrapolated to DAA. On the contrary, some clinical events, such as HCC, herpes virus and hepatitis B virus reactivations, have been suggested to be related with the use of DAA combinations.[14–18]

Specifically, for herpes virus infections, a potentially high frequency of varicella-zoster virus (VZV) reactivations was reported after all-oral DAA regimens in HIV seronegative patients.[14] It is not known whether DAA use in HIV/HCV coinfection may be associated with a greater likelihood of those infections. If DAA use was related with emergent infections or reactivation of latent infections, HIV/HCV-coinfected patients could be a high-risk group for those events or other events associated with an altered immune response. Because of these, we report the occurrence of severe infections after starting interferon-free DAA combinations in HIV/HCV-coinfected patients.