Pegylated Interferon/Ribavirin for Acute Hepatitis C Infection in HIV Positive Patients

Among hepatitis C virus (HCV) monoinfected individuals, studies have shown that interferon-based treatment during acute infection produces a high rate of sustained response. This strategy, however, has been less extensively studied in HIV/HCV coinfected patients.

At the recent XVI International AIDS Conference in Toronto, researchers from Moscow, Russia -- where there has been an outbreak of acute hepatitis C among HIV positive individuals - reported on the efficacy of 24-week treatment using pegylated interferon plus ribavirin. (The standard treatment duration for chronic hepatitis C is 24 weeks for HCV genotypes 2 or 3 and 48 weeks for genotype 1, though some studies have suggested that coinfected patients may benefit from longer courses of therapy.)

The open-label study included 32 HIV positive patients with documented HCV antibody seroconversion within the prior 6 months and persistent detectable serum HCV RNA 12 weeks after diagnosis. (Most individuals who spontaneously clear HCV without treatment will do so within this time frame.) The majority (79%) were men, the mean age was 29 years (range 19-39), and about 90% had a history of injection drug use.

Participants were treated with 1.5 mcg/kg once weekly pegylated interferon alpha-2b (Peg-Intron) plus 800-1000 mg/day ribavirin for 24 weeks. HCV RNA, HIV RNA, CD4 cell counts, blood counts, and liver enzymes were measured at baseline and at weeks 4, 12, 24, 48.

Results

All 32 treated patients had baseline CD4 counts above 200 cells/mm3.

81% were virologically stable on HAART, with HIV viral loads below 400 copies/mL.

The median HCV RNA level at the start of treatment was 775,300 IU/mL.

28% of patients had HCV genotypes 1 or 4, while 72% had genotypes 2 or 3.

At 4 weeks, early virological response (negative HCV RNA) and biochemical response (normalization of aminotransferase [ALT and AST] levels) were observed in 14 patients (44%).

By 12 weeks, 30 patients (94%) were HCV RNA negative.
" At the end of 24 weeks of treatment, 94% patients remained HCV RNA negative (end-of-treatment response).

75% of patients remained HCV RNA negative 24 weeks after the end of treatment (sustained virological response).

For patients with genotypes 1 or 4, the end-of-treatment response rate was 89% and the sustained virological response rate was 67%.

For those with genotypes 2 or 3, the corresponding rates were 95% and 78%.

2 patients (6%) discontinued therapy due to severe depression.

Conclusion

The researchers concluded that after 24 week of therapy for acute hepatitis C, a majority of HIV positive patients achieved sustained virological response, suggesting that this is a viable treatment strategy for this population.

09/08/06

Reference
A Kruk and N Polovinkina. Efficacy of a 24 week course of acute HCV treatment with peg-interferon a-2b and ribavirin in HIV-infected patients. XVI International AIDS Conference. Toronto, August 13-18, 2006. Abstract WEAX0102/10676.