The Efficacy and Safety of Direct-Acting Antiviral Regimens for HCV/HIV Co-infection: A Systematic review and Network meta-analysis.

Background and Aim Various all-oral direct-acting antiviral (DAA) regimens are being widely used in the treatment of human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infected patients; however, the comparative efficacy and safety of different types and combinations of DAAs are not completely clear. There is still a lack of integration of evidence for optimized therapies for HIV/HCV co-infection. Methods We conducted a systematic literature search in several databases up to January 1, 2020. All the studies that reported the sustained virologic response (SVR) and adverse events of DAAs in HIV/HCV co-infected patients were included. The Bayesian Markov Chain Monte Carlo method was used for the pooled estimates of network meta-analysis. Results We identified 33 eligible articles with 7 combinations of all-oral DAAs for the analyses of efficacy and safety. Grazoprevir-elbasvir +/- ribavirin (GZR/EBR +/- RBV: 95.6%; 95% CrI, 91.7-98.1%), ombitasvir/paritaprevir/ritonavir and dasabuvir +/- ribavirin (3D +/- RBV: 95.3%; 95% CrI, 93.4-96.9%), sofosbuvir-ledipasvir +/- ribavirin (SOF/LDV +/- RBV: 95.2%; 95% CrI, 93.7-96.6%), and sofosbuvir-daclatasvir +/- ribavirin (SOF/DCV +/- RBV: 94.8%; 95% CrI, 92.5-96.6%) were the most effective combinations for HIV/HCV co-infected patients, with SVR rates of approximately 94% and above while severe adverse events were rare. However, the SVR rates of sofosbuvir-ribavirin (SOF/RBV) and sofosbuvir-simeprevir +/- ribavirin (SOF/SMV +/- RBV) both failed to reach 90%, and the incidences of adverse events were higher than 5%. Conclusions Efficacy and safety of all-oral DAAs were in prospect for HIV/HCV co-infection patients. GZR/EBR +/- RBV was the optimal combination recommended for HIV/HCV co-infected patients based on the excellent treatment effects and insignificant adverse events.