• Jürgen K Rockstroh, Karine Lacombe, Rolando M Viani, Chloe Orkin, David Wyles, Anne F Luetkemeyer, Ruth Soto-Malave, Robert Flisiak, Sanjay Bhagani, Kenneth E Sherman, Tatiana Shimonova, Peter Ruane, Joseph Sasadeusz, Jihad Slim, Zhenzhen Zhang, Suvajit Samanta, Teresa I Ng, Abhishek Gulati, Matthew P Kosloski, Nancy S Shulman, Roger Trinh, and Mark Sulkowski.
• Department of Medicine, Universitätsklinikum Bonn, Germany.
• Clin. Infect. Dis. 2018 Sep 14; 67 (7): 1010-1017.

BackgroundOnce-daily glecaprevir coformulated with pibrentasvir (glecaprevir/pibrentasvir) demonstrated high rates of sustained virologic response 12 weeks after treatment (SVR12) in patients with hepatitis C virus (HCV) genotype 1-6 infection. This phase 3 study evaluated the efficacy and safety of glecaprevir/pibrentasvir in patients with chronic HCV genotype 1-6 and human immunodeficiency virus type 1 (HIV-1) coinfection, including patients with compensated cirrhosis.MethodsEXPEDITION-2 was a phase 3, multicenter, open-label study evaluating glecaprevir/pibrentasvir (300 mg/120 mg) in HCV genotype 1-6/HIV-1-coinfected adults without and with compensated cirrhosis for 8 and 12 weeks, respectively. Patients were either HCV treatment-naive or experienced with sofosbuvir, ribavirin, or interferon, and antiretroviral therapy (ART) naive or on a stable ART regimen. Treatment-experienced genotype 3-infected patients were excluded. The primary endpoint was the SVR12 rate.ResultsIn total, 153 patients were enrolled, including 16 (10%) with cirrhosis. The SVR12 rate was 98% (n = 150/153; 95% confidence interval, 95.8-100), with no virologic failures in 137 patients treated for 8 weeks. One genotype 3-infected patient with cirrhosis had on-treatment virologic failure. Most adverse events were mild in severity; 4 patients (2.6%) had serious adverse events, all deemed unrelated to glecaprevir/pibrentasvir. Treatment discontinuation was rare (<1%). All patients treated with ART maintained HIV-1 suppression (<200 copies/mL) during treatment.ConclusionsGlecaprevir/pibrentasvir for 8 weeks in noncirrhotic and 12 weeks in cirrhotic patients is a highly efficacious and well-tolerated treatment for HCV/HIV-1 coinfection, regardless of baseline HCV load or prior treatment with interferon or sofosbuvir.Clinical Trial RegistrationNCT02738138.

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