Intrahepatic Viral Kinetics During Direct-Acting Antivirals for Hepatitis C in Human Immunodeficiency Virus Coinfection: The AIDS Clinical Trials Group A5335S Substudy
Open Access
- 22 July 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in The Journal of Infectious Diseases
- Vol. 222 (4), 601-610
- https://doi.org/10.1093/infdis/jiaa126
Abstract
Background. Direct-acting antivirals (DAAs) targeting hepatitis C virus (HCV) have revolutionized outcomes in human immunodeficiency virus (HIV) coinfection. Methods. We examined early events in liver and plasma through A5335S, a substudy of trial A5329 (paritaprevir/ritonavir, ombitasvir, dasabuvir, with ribavirin) that enrolled chronic genotype 1a HCV-infected persons coinfected with suppressed HIV: 5 of 6 treatment-naive enrollees completed A5335S. Results. Mean baseline plasma HCV ribonucleic acid (RNA) =6.7 log(10) IU/mL and changed by -4.1 log(10) IU/mL by Day 7. In liver, laser capture microdissection was used to quantify HCV. At liver biopsy 1, mean %HCV-infected cells=25.2% (95% confidence interval [CI], 7.4%-42.9%), correlating with plasma HCV RNA (Spearman rank correlation r=0.9); at biopsy 2 (Day 7 in 4 of 5 participants), mean %HCV-infected cells=1.0% (95% CI, 0.2%-1.7%) (P<.05 for change), and DAAs were detectable in liver. Plasma C-X-C motif chemokine 10 (CXCL10) concentrations changed by mean=-160 pg/mL per day at 24 hours, but no further after Day 4. Conclusions. We conclude that HCV infection is rapidly cleared from liver with DAA leaving <2% HCV-infected hepatocytes at Day 7. We extrapolate that HCV eradication could occur in these participants by 63 days, although immune activation might persist. Single-cell longitudinal estimates of HCV clearance from liver have never been reported previously and could be applied to estimating the minimum treatment duration required for HCV infection.Funding Information
- AbbVie
- AIDS Clinical Trials Group
- National Institutes of Health (R01 AI116868, K24 DA034621, K23 AI108355)
- Johns Hopkins University Center for AIDS Research (P30 AI094189)
- Johns Hopkins University Clinical Research Site (UM1 AI069465)
- University of Puerto Rico AIDS Clinical Trials Unit (UM1 AI069415)
- National Institute of Allergy and Infectious Diseases (UM1 AI068634, UM1 AI068636, UM1 AI106701)
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