Treatment of HCV NS3/4a protease inhibitor experienced patients with sofosbuvir containing regimens in an Outpatient Clinic

AbstractBackgroundWe assessed the success rate of retreatment with a sofosbuvir containing regimen in HIV/ HCV genotype 1 coinfected patients who failed a regimen containing a HCV protease inhibitor in a HIV Primary care clinic.MethodsA retrospective review of outpatient medical records was conducted to identify HCV Genotype 1 coinfected patients whose last HCV regimen included an NS3/4a protease inhibitor, had failed treatment, and were retreated with sofosbuvir containing regimen between January 2014-December 2015. All had suppressed HIV viremia prior to treatment initiation. HIV and HCV care was provided by the primary provider who consisted of 4 infectious disease physicians, two internists and one physician assistant. Referral to a Hepatologist and medication review by a Pharmacist was decided by the primary provider. Age gender, ethnicity, prior HCV treatment regimen, change in antiretroviral regimen and SVR 12 rates were collected and tabulated.Results14 patients were retreated during this two year period; 13 males and 1 female. 4(29%) were Black, 8(57%) Caucasian, 2(14%) Hispanic. Age ranged from 37 to 69. 12(86%) had genotype 1a, 1 (7%) genotype 1b, 1 had genotype 1a/1b. 9(64%) were treated previously with Pegylated Interferon-Ribavirin (Peg-RBV) plus telaprevir, 2 (14%) simeprevir/sofosbuvir, 1 (7%)Peg-RBV/faldaprevir, 1(7%) Peg-RBV/ simeprevir, 1(7%) Peg-RBV/sofosbuvir. HIV regimen was changed in 5(36%) patients prior to HCV treatment due to drug-drug interactions. 7(50%) patients were F4, 1(7%) patient was F2–3, 3(21%) patients were F2, 2(14%) patients were F1, 1 (7%) patient had an unknown fibrosis status. 10(71%) were treated with ledipasvir/sofosbuvir, 2(14%) were treated with simeprevir/sofosbuvir, 1(7%) was treated with ledipasvir/sofosbuvir/ribavirin, 1(7%) was treated with Peg-RBV/sofosbuvir. 13(93%) patients obtained an SVR12 and 1 (7%) patient was lost to follow up after 8 weeks of ledipasvir/sofosbuvir.ConclusionIn this group of HIV coinfected Genotype 1 HCV NS3/4a protease inhibitor experienced patients, retreated with ledipasvir/sofosbuvir with or without ribavirin and Peg-RBV-sofosbuvir, 93% SVR12 was achieved in a HIV primary care setting. HIV/HCV treatment was delivered using a multidisciplinary approach.Disclosures J. Faragon, Abbvie, BMS, Gilead, Janssen, Merck: Speaker’s Bureau, Speaker honorarium; P. Ells, ABBVIE, GILEAD, MERCK: Speaker’s Bureau, Speaker honorarium