Treatment of HCV NS3/4a Protease Inhibitor Experienced Patients with Sofosbuvir Containing Regimens in an Outpatient Clinic

BACKGROUND: We assessed the success rate of retreatment with a sofosbuvir containing regimen in HIV/ HCV genotype 1 coinfected patients who failed a regimen containing a HCV protease inhibitor in a HIV Primary care clinic. METHODS: A retrospective review of outpatient medical records was conducted to identify HCV Genotype 1 coinfected patients whose last HCV regimen included an NS3/4a protease inhibitor, had failed treatment, and were retreated with sofosbuvir containing regimen between January 2014-December 2015. All had suppressed HIV viremia prior to treatment initiation. HIV and HCV care was provided by the primary provider who consisted of 4 infectious disease physicians, two internists and one physician assistant. Referral to a Hepatologist and medication review by a Pharmacist was decided by the primary provider. Age gender, ethnicity, prior HCV treatment regimen, change in antiretroviral regimen and SVR 12 rates were collected and tabulated. RESULTS: 14 patients were retreated during this two year period; 13 males and 1 female. 4(29%) were Black, 8(57%) Caucasian, 2(14%) Hispanic. Age ranged from 37 to 69. 12(86%) had genotype 1a, 1 (7%) genotype 1b, 1 had genotype 1a/1b. 9(64%) were treated previously with Pegylated Interferon-Ribavirin (Peg-RBV) plus telaprevir, 2 (14%) simeprevir/sofosbuvir, 1 (7%)Peg-RBV/faldaprevir, 1(7%) Peg-RBV/ simeprevir, 1(7%) Peg-RBV/sofosbuvir. HIV regimen was changed in 5(36%) patients prior to HCV treatment due to drug-drug interactions. 7(50%) patients were F4, 1(7%) patient was F2–3, 3(21%) patients were F2, 2(14%) patients were F1, 1 (7%) patient had an unknown fibrosis status. 10(71%) were treated with ledipasvir/sofosbuvir, 2(14%) were treated with simeprevir/sofosbuvir, 1(7%) was treated with ledipasvir/sofosbuvir/ribavirin, 1(7%) was treated with Peg-RBV/sofosbuvir. 13(93%) patients obtained an SVR12 and 1 (7%) patient was lost to follow up after 8 weeks of ledipasvir/sofosbuvir. CONCLUSION: In this group of HIV coinfected Genotype 1 HCV NS3/4a protease inhibitor experienced patients, retreated with ledipasvir/sofosbuvir with or without ribavirin and Peg-RBV-sofosbuvir, 93% SVR12 was achieved in a HIV primary care setting. HIV/HCV treatment was delivered using a multidisciplinary approach. DISCLOSURES: J. Faragon, Abbvie, BMS, Gilead, Janssen, Merck: Speaker’s Bureau, Speaker honorarium; P. Ells, ABBVIE, GILEAD, MERCK: Speaker’s Bureau, Speaker honorarium