The authors have been examining a small cohort of 18 HIV/HCV coinfected patients enrolled in a prospective, observational study in Italy. All of the patients received successful antiretroviral therapy, 15 had F3-F4 hepatic fibrosis and three had F2 hepatic fibrosis. Patients were treated with direct-acting antivirals (DAA): 11 on ledipasvir/sofosbuvir, three on sofosbuvir/daclatasvir, and four on ombitasvir/paritaprevir/ritonavir/dasabuvir/ribavirin. All patients achieved a sustained virologic response (SVR). Samples were collected just before starting DAA treatment, at the end of treatment (EOT) and 12 weeks following EOT (SVR). The frequency of Treg and myeloid-derived suppressor cells (MDSC) were analysed. The authors found that at baseline, a higher frequency of Treg and MDSC were seen in HIV/HCV coinfected patients than in healthy donors. DAA treatment did not modify this frequency of Treg, which persisted significantly higher than in controls during the entire study period. DAA treatment also failed to normalise MDSC frequency and this actually increased at SVR. Therefore DAAs may fail to restore regulatory immune cell subsets (Treg and MDSC) in both HCV mono- and HIV/HCV coinfected patients and the clinical effect of this persistence is currently unknown.
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