Author information

• ¹Department of Medicine, University of California, San Francisco, CA, USA.
• ²Institute of Virology, University of Maryland, MD, USA.
• ³Department of Medicine, University of Southern California, Los Angeles, CA, USA.
• ⁴Department of Surgery, University of California, San Francisco, CA, USA.
• ⁵Department of Medicine, Mount Sinai Hospital, New York, NY, USA.
• ⁶Transplantation Institute, Mount Sinai Hospital, New York, NY, USA.
• ⁷Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
• ⁸Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
• ⁹Department of Medicine, Columbia University, New York, NY, USA.
• ¹⁰Department of Surgery, Columbia University, New York, NY, USA.
• ¹¹Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
• ¹²Medstar Georgetown Transplant Institute, Georgetown University, Georgetown, DC, USA.
• ¹³Department of Critical Care Medicine, National Institutes of Health, Bethesda, MD, USA.

Abstract

Direct acting antiviral (DAA) therapy has transformed the management of human Immunodeficiency virus (HIV) and hepatitis C (HCV) coinfected patients with advanced liver disease. STOP-Coinfection was a multi-center prospective and retrospective, open-label study using sofosbuvir-based DAA therapy to treat HIV/HCV coinfected participants pre- or post-liver transplant (LT). Sixty-eight participants with end stage liver disease (Child-Turcotte-Pugh score ≥7 and Model for End-Stage Liver Disease score 6-29) were enrolled, 26 had hepatocellular carcinoma. Forty-two participants were treated pre-LT and 26 post-LT. All participants completed therapy without need for dose reduction or transfusion; 8 required 2 or more courses of therapy. Ninety-three% achieved a sustained virologic response and DAA therapy was well tolerated. Despite HCV cure, 12 end-stage liver disease participants required subsequent LT, 7 for decompensated liver disease. Thirteen participants died, 10 with decompensated liver disease pre-LT and 3 post-LT. Overall, transplant free survival was 42.8% at 4 years and post-LT survival was 87.9% at 5 years. We conclude that sofosbuvir-based DAA therapy is safe and highly effective in HCV-HIV patients with decompensated liver disease and post-LT, with post-LT survival rates comparable to other indications. This removes one of the last barriers to liver transplantation in this challenging cohort of recipients.