Naturally Occurring Resistance Associated Substitutions in Non-Cirrhotic, Treatment Naive HCV–HIV Co-Infected Patients Does Not Affect the Treatment Response for Anti-HCV Antiviral Therapy

Ekta Gupta,1 Reshu Agarwal,1 Aayushi Rastogi,2 Nitiksha Rani,1 Ankur Jindal3 1Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India; 2Department of Epidemiology, Institute of Liver and Biliary Sciences, New Delhi, India; 3Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, IndiaCorrespondence: Ekta GuptaDepartment of Clinical Virology, Institute of Liver and Biliary Sciences, Sector D1, Vasant Kunj, New Delhi, 110070, IndiaTel + 91 11 46300000Fax + 91 11 26123501Email ektagaurisha@gmail.comPurpose: Limited literature on the prevalence of baseline resistance associated substitutions (BL-RAS) among HCV–HIV co-infected patients and their association with treatment outcomes is available especially from India. Hence, the present study aimed to study naturally occurring RAS among non-cirrhotic HCV–HIV co-infected patients and their impact on the response to anti-HCV therapy.Patients and Methods: In this retrospective study, archived blood samples of 80 HCV–HIV co-infected patients, before anti-HCV therapy initiation, were tested for substitutions at the drug acting sites (NS5a and NS5b) in the HCV genome by direct PCR sequencing.Results: BL-RAS were seen in 19 (23.7%) patients. As well as BL-RAS, all patients were given sofosbuvir (SOF) 400 mg+ daclatasvir (DCV) 60 mg for 12 weeks. Overall, sustained virological response (SVR) was achieved in 63 (78.8%) patients, in 13 with BL-RAS and in 50 without BL-RAS. All the SVR failure cases (n=17) were retreated with SOF (400 mg) +DCV (60 mg)+ ribavirin (RBV) for 24 weeks. SVR was eventually attained in 14 (82.3%) patients, in 4/6 (66.6%) with BL-RAS and in 10/11 (91%) without BL-RAS. On univariate analysis, age more than 30 years (OR: 11.6; 95% CI: 3.0– 45.5, p-value< 0.001) and female gender (OR: 8.6; 95% CI: 1.1− 69, p-value < 0.009) were found to be significant factors associated with the attainment of SVR.Conclusion: BL-RAS are common in HCV–HIV co-infected patients. The existence of BL-RAS, however, did not affect the attainment of SVR among non-cirrhotic, treatment naive HCV–HIV co-infected patients.Keywords: HCV–HIV co-infection, drug resistance, direct acting antiviral, resistance associated substitutions