Efficacy and safety of direct acting antiviral regimens for hepatitis C virus and human immunodeficiency virus co‐infection: systematic review and network meta‐analysis.

Background and Aim: Various all‐oral direct‐acting antiviral (DAA) regimens are being widely used in the treatment of human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co‐infected patients; however, the comparative efficacy and safety of different types and combinations of DAAs are not completely clear. There is still a lack of integration of evidence for optimized therapies for HIV/HCV co‐infection. Methods: We conducted a systematic literature search in several databases up to January 1, 2020. All the studies that reported the sustained virologic response (SVR) and adverse events of DAAs in HIV/HCV co‐infected patients were included. The Bayesian Markov Chain Monte Carlo method was used for the pooled estimates of network meta‐analysis. Results: We identified 33 eligible articles with 7 combinations of all‐oral DAAs for the analyses of efficacy and safety. Grazoprevir–elbasvir ± ribavirin (GZR/EBR ± RBV: 95.6%; 95% CrI, 91.7–98.1%), ombitasvir/paritaprevir/ritonavir and dasabuvir ± ribavirin (3D ± RBV: 95.3%; 95% CrI, 93.4–96.9%), sofosbuvir–ledipasvir ± ribavirin (SOF/LDV ± RBV: 95.2%; 95% CrI, 93.7–96.6%), and sofosbuvir–daclatasvir ± ribavirin (SOF/DCV ± RBV: 94.8%; 95% CrI, 92.5–96.6%) were the most effective combinations for HIV/HCV co‐infected patients, with SVR rates of approximately 94% and above while severe adverse events were rare. However, the SVR rates of sofosbuvir–ribavirin (SOF/RBV) and sofosbuvir–simeprevir ± ribavirin (SOF/SMV ± RBV) both failed to reach 90%, and the incidences of adverse events were higher than 5%. Conclusions: Efficacy and safety of all‐oral DAAs were in prospect for HIV/HCV co‐infection patients. GZR/EBR ± RBV was the optimal combination recommended for HIV/HCV co‐infected patients based on the excellent treatment effects and insignificant adverse events. [ABSTRACT FROM AUTHOR]