Early emergence of opportunistic infections after starting direct‐acting antiviral drugs in HIV/HCV‐coinfected patients

HEPAVIR, GEHEP and RIS‐HEP07 study groups.Varicella‐zoster virus and hepatitis B virus reactivations have been reported after starting interferon‐free direct‐acting antiviral agent (DAA ) combinations. HIV /HCV ‐coinfected patients could be a high‐risk group for the reactivation of latent infections. Because of these, we report the occurrence of severe infections after starting DAA regimens in HIV /HCV ‐coinfected patients. Individuals included in the HEPAVIR ‐DAA (NCT 02057003) cohort were selected if they had received all‐oral DAA combinations. A retrospective review of clinical events registered between the start of DAA s and 12 months after SVR 12 was carried out. Overall, 38 (4.5%) of 848 patients presented infections. The incidence (95% confidence interval) of infections was 4.6 (3.3‐6.3) cases per 100 person‐years. The median (Q1‐Q3) time to the infection since baseline was 23 (7.3‐33) weeks. Five (13%) of the patients with infections died; four of them had cirrhosis. The frequency of previous AIDS was 21 (54%) for patients with infections and 324 (40%) for those without infections (P = 0.084). The median (Q1‐Q3) nadir CD 4 cell count of individuals with and without infections was 75 (53‐178) and 144 (67‐255) cells/μL, respectively (P = 0.047). Immunodepression‐associated infections were observed in 9 (1.1%) patients. All of them had suppressed HIV replication with antiretroviral therapy. In conclusion, severe infections are relatively common among HIV /HCV ‐coinfected patients receiving all‐oral DAA combinations. Some unusual reactivations of latent infections in patients with suppressed HIV replication seem to be temporally linked with DAA use.This study was partly supported by grants from the Ministerio de Economía, Industria y competitividad, Instituto de Salud Carlos III (grant no: PI15/01607; grant no: PI16/01443) and from the Grupo para el Estudio de las Hepatitis Víricas (GEHEP) from SEIMC (grant no: GEHEP011). J.M. is the recipient of a grant from the Servicio Andaluz de Salud de la Junta de Andalucía (grant number B‐0037). J.A.P. is the recipient of an intensification grant from the Instituto de Salud Carlos III (grant number Programa‐I3SNS). This work has been partially funded by the Spanish AIDS Research Network RD16/0025/0010‐ISCIII‐FEDER.Peer reviewe