Direct acting antivirals eradicate HCV from the liver quickly in people with HIV but do not fully reverse immune activation

Background: Hepatitis C virus (HCV) infects nearly one-fourth of people with HIV (PWH). The role of direct-acting antivirals (DAAs) on immune activation in PWH and HCV is poorly understood.

Methods: We quantified plasma HCV RNA and CXCL10 in persons with HCV mono- versus HIV/HCV co-infection receiving Sofosbuvir-Velpatasvir. Single-cell laser capture was applied to liver biopsies obtained before and within 4-7 days of DAA initiation to estimate HCV clearance and changes in interferon stimulated genes (ISGs).

Results: We enrolled ten people with chronic genotype 1a HCV: five were PWH. Median (min-max) ages at enrollment were 55.5 (28-66) years, five were women, and eight were African American. At baseline, plasma HCV RNA levels were 6.36 (5.68-7.93) log10 IU/mL; all had transient elastography liver stiffness < 9 kPa. CD4+ T cell counts in PWH were 768 (244-1136) cells/µL. All had suppressed HIV viremia on antiretrovirals.First and second phase plasma HCV RNA kinetics were not different between groups. Median (min-max) proportions of infected hepatocytes at biopsy 1 were 0.06 (0.01-0.59) in HCV mono- and 0.21 (0.04-0.87) in HIV/HCV co-infection and did not differ. Participants had lower intracellular HCV RNA levels at biopsy 2, but not differentially by HIV status. CXCL10 levels declined in both groups but was higher in co- than in mono-infection even at the end of treatment. Proportion of cells expressing ISGs diminished in mono- but increased in co-infection.

Conclusion: Whereas DAAs rapidly cleared intrahepatic HCV in both groups, immune activation was slower to diminish in PWH. Residual immune activation in PWH warrants further exploration.