A real-world study of the efficacy of a simplified pill count-based strategy for treating HCV/HIV coinfection patients

BACKGROUND: Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections are major public health issues throughout the world. In resource-limited areas, successful treatment of HCV/HIV coinfection frequently faces challenges, particularly restricted access to drugs and poor treatment compliance. However, data comparing single-tablet regimen (STR) versus multi-tablet regimen (MTR) direct-acting antiviral (DAA) strategies, specifically focusing on pill burden, remain scarce in such settings. METHODS: This single-center, retrospective cohort study enrolled patients with HCV/HIV coinfection between April 2023 and October 2025. All patients received DAA therapy in addition to the antiretroviral therapy (ART). Participants were divided into DAA STR (one pill daily) and DAA MTR (multiple pills daily) groups. The primary endpoint was sustained virologic response at least 12 weeks after completion of treatment (SVR). RESULTS: A total of 105 patients with HCV/HIV coinfection were enrolled. The overall SVR rate was 96.2% (101/105). The DAA STR group had a numerically higher SVR rate than the DAA MTR group (98.8% vs. 88.0%, P = 0.041); however, this comparison was confounded by genotype. In a sensitivity analysis limited to non-genotype 3b patients (n = 87), SVR rate was 98.8% in the DAA STR group and 85.7% in the DAA MTR group (P = 0.155). The DAA STR demonstrated a numerical advantage in achieving SVR in all subgroups stratified by sex, age, HCV infection route, baseline HCV RNA level, HCV genotype, and ART regimen. Univariate logistic regression identified DAA regimen was the only factor associated with SVR (OR 10.773, 95% CI 1.067-108.743); however, because only 4 participants failed to achieve SVR, this analysis was exploratory and the estimate was statistically unstable. CONCLUSIONS: In this real-world study, both DAA STR and DAA MTR achieved high overall SVR rates in HCV/HIV coinfection in a resource-limited setting. The simplified DAA STR was associated with a numerically higher SVR, but the comparison was confounded by the selective allocation of genotype 3b patients to DAA MTR. The observed difference between DAA STR and DAA MTR may reflect treatment selection practices and genotype distribution rather than an independent effect of regimen simplification. The simplified pill count-based strategy remains a practical option, but its advantage over MTR was confounded by genotype selection in this cohort. Our findings support the feasibility of both approaches and highlight the need for large, prospective, genotype-balanced comparative studies with integrated adherence monitoring.