Publications & Reports

Virological responses during treatment for recent hepatitis C virus: Potential benefit for ribavirin use in HCV/HIV co-infection.

Grebely J, Hellard M, Applegate T, Petoumenos K, Yeung B, Feld JJ, Rawlinson W, Lloyd AR, George J, Kaldor JM, Dore GJ, Matthews GV
aThe Kirby Institute for infection and immunity in society, University of New South Wales (UNSW), Sydney, Australia bCentre for Population Health, Burnet Institute, Melbourne, Australia cInfectious Diseases Unit, The Alfred Hospital, Melbourne, Australia

Abstract

OBJECTIVE:: The role of ribavirin in the treatment of recent HCV (acute/early chronic) is unclear, particularly in HIV+ individuals. This study evaluated early virological decline during recent HCV therapy in HIV- individuals receiving PEG-IFN monotherapy and HIV+ individuals receiving PEG-IFN/ribavirin. DESIGN:: ATAHC was a non-randomised prospective study of patients with recent HCV. All participants received PEG-IFN (24 weeks); HCV/HIV participants also received ribavirin. Early HCV RNA decline was assessed among adherent participants (>/=80% PEG-IFN, >/=80% treatment). Logistic regression identified predictors of RVR (<10 IU/mL). RESULTS:: Of 109 treated, 82% were adherent (HCV, n = 57; HCV/HIV, n = 32). Overall, RVR was 51% (HCV: 55% vs. HCV/HIV: 43%, P = 0.323). Factors independently associated with RVR included duration of infection <26 weeks, HCV RNA <5.6 log10 IU/mL at baseline and HCV genotype 2/3 infection. Between baseline and week 12, mean decline in HCV RNA was greater in HCV/HIV participants (PEG-IFN/ribavirin) compared to HCV participants (PEG-IFN) (4.19 vs. 3.32 log10 IU/mL, P = 0.029). Greater HCV RNA decline was observed in those treated with RBV, particularly amongst those with an estimated duration of infection >/=26 weeks and those with unfavourable IL28B genotypes. Adherent HIV negative and positive participants had similar EVR (76 vs. 90%,P = 0.102) and SVR (63% vs. 75%,P = 0.253), respectively. RVR was highly predictive of SVR (AOR 4.09; 1.49, 11.25). CONCLUSION:: The results of this study suggest a potential benefit for PEG-IFN and ribavirin combination therapy in maximizing virological responses in HCV/HIV participants with recent HCV, particularly those with a longer duration of HCV infection and unfavorable IL28B genotypes.

Publication

  • Journal: AIDS
  • Published: 03/05/2012
  • Volume: 26
  • Issue: 13
  • Pagination: 1653-1661

Author

Health Issues