Evaluating the generalizability of clinical trials of direct-acting antivirals for HIV–hepatitis C virus coinfection
HIV coinfection accelerates hepatitis C virus (HCV) progression and interferon-based therapies have shown relatively poor efficacy and tolerability in the HIV–HCV-coinfected population. The introduction of direct-acting antivirals (DAAs) for the treatment of HCV represented a paradigm shift leading to cure of chronic HCV infection, and was held to be a promising alternative for patients with HIV–HCV coinfection. Clinical trials have demonstrated the efficacy and tolerability of various DAAs in patients with HIV–HCV coinfection, bringing the added benefits of simplified dosing and shorter treatment times. However, there continues to be significant concern about the generalizability of DAA clinical trial results to the highly heterogeneous population of patients with HIV–HCV coinfection.