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

Purpose: 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 BLRAS, however, did not affect the attainment of SVR among non-cirrhotic, treatment naive HCV-HIV co-infected patients.