Efficacy and safety of directly acting antiviral drugs in HCV patients with HIV in liver transplantation: A meta-analysis

Background

HCV/HIV co-infections were initially a contentious consideration for liver transplantation, primarily due to their suboptimal response to interferon-based treatments and unfavorable post-transplantation outcomes. The potential concern in this patient group arises from drug–drug interactions between DAAs and ARVs, with data on the effectiveness and safety of DAAs in this demographic primarily derived from isolated case studies. This extensive review assesses the safety and efficacy of DAAs in liver transplants for individuals with concurrent HIV and HCV infections.

Methods

Conducting a systematic search across multiple databases until April 2023, our primary focus was the evaluation of outcomes, specifically the proportion of sustained virologic responses at week 12 following therapy (SVR12). To gauge publication bias, we scrutinized funnel plots and conducted Egger tests.

Results

Nine studies encompassed a participant pool of 269 individuals, with a statistical estimate of SVR12 at 92% (95% CI: 88–95). Subgroup analysis showed that the ratio of binding SVR12 of genotype (GT) 1a was 97% (95% CI: 87–100), while that of GT3 was 100% (95% CI: 92–100); 88% (95%CI: 80–95) for pre-transplant treatments; and 95% (95%CI: 91–99) for post-transplant treatments subgroup. A total of 8 patients died during SVR12 completion while 269 had a survival rate of 99% (95% CI 97–100). After one year of follow-up, four studies recorded a 98% survival rate (95% CI 94–100). Egger's test did not reveal any publication bias.

Conclusion

Administration of DAAs during liver transplantation for HCV patients with HIV infections has a high efficacy and safety. Early consideration of HCV therapy should be the goal for all liver transplant recipients.