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Editorial |

Quantum Leaps, Microeconomics, and the Treatment of Patients With Hepatitis C and HIV Coinfection

Michael S. Saag, MD1
[+] Author Affiliations
1Department of Medicine, the University of Alabama School of Medicine, Birmingham
JAMA. 2014;312(4):347-348. doi:10.1001/jama.2014.7735.
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Until very recently, patients with hepatitis C virus (HCV) infection were treated with pegylated-interferon administered weekly by subcutaneous injection plus ribavirin given orally twice daily. Over the last decade, however, by virtue of development of directly acting agents, therapy for hepatitis C infection has advanced by several orders of magnitude, creating a transformative and unprecedented revolution.

Telaprevir and boceprevir were the first directly acting agents released. In previous studies among patients with HCV genotype 1 only (ie, without human immunodeficiency virus [HIV] coinfection), treatment with pegylated-interferon-ribavirin plus either boceprevir or telaprevir achieved sustained virologic response rates at 24 weeks after cessation of therapy (SVR 24 or “cure”) of 60% to 75% with 24 to 48 weeks of treatment.13 For those monoinfected with genotype 2 or 3, SVR-48 rates of approximately 80% were reported with 48 to 72 weeks of treatment with pegylated-interferon plus ribavirin alone.4,5 Patients who are coinfected with HIV and HCV have similar outcomes as those with HCV monoinfection but require a longer duration of therapy with those treatments (48 weeks). Coinfected patients with genotype 1 infection treated with pegylated-interferon-ribavirin plus either telaprevir or boceprevir for 48 weeks have achieved SVR-12 and SVR-24 rates of 74% with telaprevir and 63% with boceprevir.68 However, telaprevir and boceprevir did not achieve the real promise of the directly acting agents, which is their use as components of an all-oral, interferon-free regimen.

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