Direct-acting antivirals for acute hepatitis C in HIV-infected MSM

1. European Collaborative Study. Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission. Fetal and maternal outcome after administration of tenofovir to gravid rhesus monkeys (Macaca mulatta). et al. In utero exposure to tenofovir disoproxil fumarate does not impair growth and bone health in HIV-uninfected children born to HIV-infected mothers. Safety of tenofovir use during pregnancy: early growth outcomes in HIV-exposed uninfected infants. et al. Infant growth outcomes after maternal tenofovir diso-proxil fumarate use during pregnancy. Yogev R, et al. Lower newborn bone mineral content associated with maternal use of tenofovir disoproxil fumarate during pregnancy. Nalumenya R, et al. Pregnancy and infant outcomes among HIV-infected women taking long-term ART with and without tenofovir in the DART trial. An epidemic of acute hepatitis C (AHC) has been described amongst HIV-infected MSM [1–8]. Traditionally , treating AHC in this population has had clear advantages over waiting to treat in the chronic phase, with improved sustained virological response (SVR) rates and reduced length of therapy [9–12]. Treatment is offered to those who fail to demonstrate a 2 log decline at week 4 or still have detectable hepatitis C virus (HCV) RNA at week 12 and hence are unlikely to clear spontaneously [13]. The treatment of chronic HCV has been revolutionized by the advent of directly acting antivirals (DAAs) [14]. However, the role of these agents in AHC is unclear, particularly in light of the now-excellent efficacy in chronic infection. Guidelines still recommend therapy with pegylated interferon and ribavirin, and DAAs are not currently licensed for AHC [9,15]. Nonetheless, we have encountered several cases in which we have felt the use of DAAs warranted for AHC. The demographics and essentials of the HIVand AHC history of these patients are presented in Table 1. Patient 1 was monitored for 4 weeks, failed to reduce his viral load by 2 log and was thus considered for AHC therapy. He had a background of depression and was a healthcare professional in an important role. Two companies were therefore approached to access an all-oral, interferon-free DAA regimen, as DAAs were not licensed at this time, both of whom agreed to provide medication. Patient 2 presented with evidence of hepatic failure, with deranged clotting and low albumin, which failed to resolve after more than 10 days of …