Direct-acting antivirals: keys to eliminating the Hepatitis C virus and improving the prognosis of people with HIV

The human immunodeficiency virus (HIV) is a virus that attacks the immune system. Hepatitis C, for its part, is an infection caused by a virus (HCV) that damages the liver. What do they both have in common?

In Spain, it is estimated that 30% of the total number of people with HIV—between 130,000 and 160,000—are co-infected with HCV. A fact that would be explained because both viruses share transmission routes; In the past, HCV co-infection was common in people diagnosed with HIV, especially among injection drug users.

According to Doctor José Miguel Benito, researcher at the Health Research Institute of the Jiménez Díaz Foundation (IIS-FSJ/UAM) in the King Juan Carlos University Hospital“in Spain the most frequent route of transmission at the beginning of the epidemic –decade of the 80s and 90s of the last century- was parenteral in intravenous drug users, which meant that a high percentage of people who became infected with HIV “They were also infected with HCV.”

In this context, and as a result of concern about the impact that HCV infection can have on the clinical course of HIV, research is key to determine whether a doubly stressed immune system can worsen the health of people with HIV in the long term. . For Doctor Norma Rallón, one of the leaders of the study and also a researcher at the IIS-FJD/UAM at the Rey Juan Carlos University Hospital, “research around the topic of coinfection with HIV and HCV is very important not only because not only the health problem, given the high prevalence of HCV infection in the HIV population, but also because of the great challenge for the immune system of those infected by both viruses and all the consequences that this entails.”

The research team in Infectious Diseases and Tropical Medicine of the IIS-FJD/UAM and the university hospitals are working on this. Jiménez Díaz Foundation and Rey Juan Carlos (Móstoles), who carried out the study The Era of DAAs: Assessing the Patients. Characteristics, Clinical Impact, and Emergence of Comorbidities in HIV/HCV-Coinfected versus HIV-Infected Individuals, which was just published in Journal of Clinical Medicinein order to know if curing HCV infection can change the clinical course of people co-infected with HIV and HCV.

The problem of HIV/HCV coinfection

In general, coinfection with HIV and HCV complicates the two diseases: the presence of both viruses in the same person generates interactions, so that one infection can alter the clinical course of the other. In the study, the researchers analyze the impact of curing HCV infection in people with HIV, specifically on the incidence of morbidity and mortality in the population infected by the two viruses.

As highlighted by Dr. Beatriz Álvarez, first signatory of the study, specialist in the Department of Infectious Diseases of the Jiménez Díaz Foundation and researcher at the Health Research Institute of the Jiménez Díaz Foundation (IIS-FJD/UAM), “people with HIV suffer a higher incidence of different pathologies and at earlier ages of life than the seronegative population due to the existence of chronic inflammation.” If we add to this the Hepatitis C virus, “this fact is aggravated” because we are talking about another virus that causes chronic infection.

The power of new direct-acting antivirals

The advances that have been achieved with drugs to treat the Hepatitis C virus have taken giant steps in the last ten years. One of these advances has come from the hand of the new direct-acting antivirals (DAAs), which have managed to revolutionize the management of people with Hepatitis C virus infection, a growing infection that is presenting new cases every time. and whose causes we should go to look for “in intravenous drug consumption and sexual transmission, especially when we combine both ingredients, as occurs with the phenomenon of chemsex —drug use for sexual purposes—and slamsex intravenously,” says Dr. Álvarez.

Thanks to these antivirals, it is possible to act directly on the replication of the virus, which makes it possible to achieve, in just two or three months, a cure rate close to 100%, fewer side effects and excellent tolerance. “This advance has completely changed the scenario of Hepatitis C, turning it into a disease with high expectations of being eradicable,” admits Dr. Álvarez. “Until the development of this type of drugs, there were only drugs to treat HCV that were ineffective, toxic and poorly tolerated, with which, to qualify for a 50% chance of cure, one had to complete a year of side effects and toxicity.” for the body,” emphasizes the expert.

But now researchers, after studying a total of 229 people co-infected with HIV and HCV together with a control group of people with HIV of similar size and characteristics, have been able to conclude that the successful elimination of HCV through DAAs significantly improves the outlook regarding comorbidities and survival in individuals co-infected with HIV/HCV, matching the prognosis of these patients to that of the comparator group. So much so that, based on them, the importance of intensifying efforts for the early detection of HCV infection and the early initiation of curative treatment, accompanied by the promotion of healthy lifestyle habits. “This approach will not only influence the prevention of liver damage in particular, but, in a more holistic way, will contribute to improving the overall health status and life expectancy of the affected people,” says Dr. Álvarez.

Finally, Dr. Rallón highlights the importance of the multidisciplinary and cooperative work of the research team, made up of personnel from the Fundación Jiménez Díaz and Rey Juan Carlos university hospitals, under the umbrella of the IIS-FJD/UAM. “We form a multidisciplinary team made up of clinical and basic researchers, which is essential for any translational research whose ultimate goal is to improve the quality of life of patients,” he adds, also thanking the support of funding entities, other centers of research with which they collaborate and, mainly, of the volunteers and patients participating in the studies.