First case worldwide of transmission of hepatitis C virus resistant to the recently approved drugs
- Researchers from the Institute for AIDS Research IrsiCaixa and the Fight Against AIDS Foundation (FLS) have described for the first time worldwide the transmission of a variant of the hepatitis C virus that is resistant to recently approved and very efficient drugs, the so-called direct-acting antivirals.
- It is the case of a man who had been previously cured, and that has been re-infected by his partner, both co-infected with HIV. Nowadays, there is a growing number of men who have sex with men who are co-infected with HIV. For this reason, co-infection of hepatitis C virus and HIV is a priority line of research of IrsiCaixa and FLS.
- Transmission of virus resistant to new very efficient antivirals can be an important clinical and public health problem. Experts emphasize the need for resistance tests and behavioral and prevention interventions in patients at high risk of hepatitis C virus reinfection.
- The article, published in the journal Gastroenterology on July 25, describes a case observed at the HIV Unit of the Germans Trias i Pujol Hospital, where IrsiCaixa, jointly funded by “la Caixa” Foundation and the Government of Catalonia Department of Health, and the FLS are located.
In 2011, new drugs against Hepatitis C virus, as Telaprevir and Boceprevir, were approved, offering new cure opportunities for infected patients. These new and more efficient drugs are the so-called direct-acting antiviral drugs against hepatitis C virus. Importantly, in the last months, a new generation of direct-acting antiviral drugs appeared: Sofosbuvir, Daclatasvir and Simeprevir. They are more potent and show a higher level of success to cure Hepatitis C virus infection.
However, the appearance of resistant virus to these new drugs can hamper their efficacy. Recently, researchers from the Institute for AIDS Research IrsiCaixa and the Fight Against AIDS Foundation have documented for the first time worldwide the sexual transmission of a variant of the hepatitis C virus that is resistant to direct-acting antiviral drugs. The article, published in the journal Gastroenterology on July 25, describes a case observed at the HIV Unit of the Germans Trias i Pujol Hospital, where IrsiCaixa, jointly funded by “la Caixa” Foundation and the Government of Catalonia Department of Health, and the Fight Against Foundation are located.
The transmission of Hepatitis C virus resistant to these new drugs from one patient to another diminishes their capacity of curing hepatitis C virus infection, lengthens the duration of the treatment and, what is more important, affects quality of life of patients with a higher probability of health complications. As the IrsiCaixa researcher Miguel Angel Martínez, one of the coordinators of the study, says, “this leads to a decrease of the cost-efficiency of these new drugs, to higher expenses for the health system, and therefore it can be an important clinical and public health problem”.
Researchers recommend resistance test before starting treatment in patients at high risk of reinfection. In addition, this case history strongly underlines that “successful treatment of hepatitis C virus does not preclude re-infection and therefore emphasizes the need for behavioral and prevention interventions in patients at increased risk for re-infection”, as explains the physician and researcher at FLS Cristina Tural, coordinator of the study.
The study has documented a case of re-infection by sexual transmission of a resistant variant of hepatitis C virus from a patient (A) to his partner (B). Both men are co-infected with HIV, and had previously been exposed to the new treatments through different clinical trials to treat hepatitis C virus infection. Patient B was cured, but the current study demonstrates that patient A, which was not cured, developed drug-resistant viruses, which were then transmitted to his partner B.
This week, the World Hepatitis Day has taken place. According to the World Health Organization (WHO) about 3% of the worldwide population is affected by Hepatitis C infection. The WHO also estimates that 4 million people contract hepatitis C virus each year, the same number of people coinfected by HIV and the hepatitis C virus. This epidemic currently affects a growing proportion of HIV-positive men who have sex with men in Europe. This represents probably one of the main sources of new hepatitis C virus infections in developed countries. For this reason, this is a priority line of research for IrsiCaixa and FLS as part of their comprehensive fight against AIDS.
Reference:
Sandra Franco, et al. Detection of a Sexually Transmitted Hepatitis C Virus Protease Inhibitor-Resistance Variant in a Human Immunodeficiency Virus–Infected Homosexual Man. Gastroenterology. 2014 May 21. pii: S0016-5085(14)00658-1 Read more