Ability of treatment week 12 viral response to predict long-term outcome in genotype 1 hepatitis C virus/HIV coinfected patients.

Abstract

OBJECTIVE:

Guidelines recommendation to extend treatment duration in genotype 1 hepatitis C virus (HCV)/HIV-coinfected patients who clear the virus later than treatment week 4 is not evidence-based. Our main objective was to study the ability of week 12 viral response [early virologic response (EVR)] to predict long-term outcome in patients treated for 48 weeks.

DESIGN:

Multicenter retrospective cohort analysis.

METHODS:

Genotype 1 HCV treatment-naive, HIV-coinfected adult patients with compensated liver disease who started combination therapy with fixed-dose pegylated-interferon (pegIFN) alfa-2a or weight-based pegIFN alfa-2b plus ribavirin were included. Univariate and forward stepwise logistic regression analysis were used to identify predictors of sustained viral response (SVR) and relapse.

RESULTS:

By intention-to-treat analysis, 31.3% (87/278) of patients achieved an SVR. SVR rate was more than three-fold higher in patients who cleared the virus by week 12 of treatment compared with late responders. Among 123 end-of-treatment responders, 36 (29.3%) relapsed. Relapse risk increased in patients with cirrhosis, in those with ribavirin dose reductions and in late responders: more than 65% of patients who cleared the virus between weeks 12 and 24 relapsed following 48 weeks of treatment compared with 10% of those attaining a complete EVR (<15 IU/ml) at treatment week 12 (risk ratio 6.4, 95% confidence interval 2.9-14.4).

CONCLUSION:

Viral response at treatment week 12 is a strong predictor of long-term outcome. Genotype 1 HCV/HIV-coinfected patients who achieve a complete EVR (<15 IU/ml) are at low risk of viral relapse after completing the standard 48 weeks of therapy.

• Authors: Eva Van den Eynde, Juan Manuel Tiraboschi, Cristina Tural, Ricard Solà, José Antonio Mira, Daniel Podzamczer, Antoni Jou, Nuria Cañete, Juan Antonio Pineda, Albert Pahissa, Manuel Crespo
• Journal: AIDS (London, England) (AIDS) Vol. 24 Issue 7 Pg. 975-82 (Apr 24 2010) ISSN: 1473-5571 [Electronic] England
• PMID: 20299963 (Publication Type: Journal Article, Multicenter Study)

Chemical References

• Antiviral Agents
• Interferon alpha-2
• Interferon-alpha
• RNA, Viral
• Recombinant Proteins
• Polyethylene Glycols
• Ribavirin
• peginterferon alfa-2a

Topics

• Adult
• Antiviral Agents (administration & dosage)
• Drug Administration Schedule
• Female
• Genotype
• HIV Infections (drug therapy, genetics, virology)
• HIV-1
• Hepacivirus (genetics)
• Hepatitis C, Chronic (drug therapy, virology)
• Humans
• Interferon alpha-2
• Interferon-alpha (administration & dosage)
• Male
• Polyethylene Glycols (administration & dosage)
• RNA, Viral (genetics)
• Recombinant Proteins
• Recurrence
• Regression Analysis
• Retrospective Studies
• Ribavirin (administration & dosage)
• Treatment Outcome
• Viral Load