Dual treatment of acute HCV infection in HIV co-infection: influence of HCV genotype upon treatment outcome.

Abstract

PURPOSE:

With DAAs still only being licensed for chronic HCV infection, the ongoing epidemic of acute hepatitis C (AHC) infection among MSM highlights the need to identify factors allowing for optimal HCV treatment outcome.

METHODS:

303 HIV-infected patients from 4 European countries with diagnosed acute HCV infection were treated early with pegylated interferon (pegIFN) and ribavirin (RBV) (n = 273) or pegylated interferon alone (n = 30).

RESULTS:

All patients were male, median age was 39 years. Main routes of transmission were MSM (95%) and IVDU (3%). 69% of patients were infected with HCV GT 1, 4.3% with GT 2, 10.6% with GT 3, 16.1% with GT 4. Overall SVR rate was 69.3% (210/303). RVR (p ≤ 0.001), 48-w treatment duration (p ≤ 0.001) and GT 2/3 (p = 0.024) were significantly associated with SVR. SVR rates were significantly higher in HCV GT 2/3 receiving pegIFN and RBV (33/35) when compared with pegIFN mono-therapy (6/10) (94% vs. 60 % respectively; p = 0.016). In multivariate analysis, pegIFN/RBV combination therapy (p = 0.017) and rapid virological response (RVR) (p = 0.022) were significantly associated with SVR in HCV GT 2/3. In HCV GT 1/4, RVR (p ≤ 0.001) and 48-w treatment duration (p ≤ 0.001) were significantly associated with SVR.

CONCLUSIONS:

Treatment of AHC GT 2 and 3 infections with pegIFN/RBV is associated with higher SVR rates suggesting different cure rates depending on HCV genotype similar to the genotype effects seen previously in chronic HCV under pegIFN/RBV. With pegIFN/RBV still being the gold standard of AHC treatment and in light of cost issues around DAAs and very limited licensed interferon-free DAA treatment options for chronic HCV GT 3 infection AHC GT 3 patients might benefit most from early interferon-containing treatment.

• Authors: Christoph Boesecke, Patrick Ingiliz, Thomas Reiberger, Hans-Jürgen Stellbrink, Sanjay Bhagani, Emma Page, Stefan Mauss, Thomas Lutz, Esther Voigt, Marguerite Guiguet, Marc-Antoine Valantin, Axel Baumgarten, Mark Nelson, Martin Vogel, Jürgen K Rockstroh, NEAT Study Group
• Journal: Infection (Infection) Vol. 44 Issue 1 Pg. 93-101 (Feb 2016) ISSN: 1439-0973 [Electronic] Germany
• PMID: 26481253 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

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

Topics

• Adult
• Antiviral Agents (administration & dosage)
• Coinfection (drug therapy)
• Drug Therapy, Combination (methods)
• Genotype
• HIV Infections (complications, drug therapy)
• Hepacivirus (classification, genetics)
• Hepatitis C (complications, drug therapy)
• Humans
• Interferon-alpha (therapeutic use)
• Male
• Middle Aged
• Polyethylene Glycols (therapeutic use)
• Prospective Studies
• Recombinant Proteins (therapeutic use)
• Ribavirin (therapeutic use)
• Treatment Outcome