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.