Ribavirin Plays a Critical Role in Early Virological Response in HIV-HCV Coinfected Patients

By Liz Highleyman

Among hepatitis C virus (HCV) monoinfected individuals, use of adequate levels of ribavirin in combination with pegylated interferon plays an important role in achieving and maintaining virological response. This also appears to be the case in HIV-HCV coinfected patients, although this group has been less extensively studied.

As previously reported, at the 8th International Congress on Drug Therapy in HIV Infection last month in Glasgow, Spanish researchers presented data from the multicenter PRESCO trial, showing that pegylated interferon alpha-2a (Pegasys) plus weight-based ribavirin produced sustained virological response (SVR) rates higher than those seen in previous studies of coinfected patients.

At the same meeting, researchers also reported further data from a comparison of early virological response (EVR) at 12 weeks in the PRESCO trial -- in which patients received 1000 mg daily ribavirin if body weight was less than 75 kg and 1200 mg daily if heavier -- and in 2 other studies:

The APRICOT trial (reported in 2004*), in which all coinfected patients in the Pegasys combination therapy arm received an 800 mg fixed dose of ribavirin;

A trial by M. Fried and colleagues (reported in 2002**), in which HCV monoinfected patients in the Pegasys combination arm received 1000-1200 weight-based ribavirin

Results

The investigators compared data from 348 patients in PRESCO, 268 in APRICOT, and 421 in the Fried study.

Virological response at Weeks 4 and 12 are is shown in the table below:

 

APRICOT

Fried et al.

PRESCO

HCV genotype 1 

Negative HCV RNA at Week 4

13.0%

31.2%

33.3%

HCV RNA drop < 1 log at Week 12

37.0%

19.5%

25.5%

HCV genotypes 2/3 

Negative HCV RNA at Week 4

37.0%

84.2%

83.7%

HCV RNA drop < 1 log at Week 12

12.0%

2.9%

2.1%

Conclusions

In conclusion, the researchers wrote, "Prescription of high ribavirin doses enhances the EVR to HCV therapy in HCV-HIV coinfected patients, with results approaching those seen in HCV monoinfected ones."

12/05/06

References

B Ramos, M Nunez, A Rendon, and others. Critical role of ribavirin for the achievement of early virological response to HCV therapy in HCV/HIV co-infected patients. 8th Congress on Drug Therapy in HIV Infection (HIV8). Glasgow. November 12-16, 2006. Abstract P314.

M Nunez, C Miralles, M A Berdun, and others. The PRESCO trial: role of extended duration of therapy with pegylated interferon alfa-2a plus weight-based ribavirin dose in 389 HCV/HIV co-infected patients. 8th Congress on Drug Therapy in HIV Infection (HIV8). Glasgow. November 12-16, 2006. Abstract PL13.1.

*F J Torriani and others (for the APRICOT Study Group). Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection in HIV-infected patients. New England Journal of Medicine 351(5): 438-450. July 29, 2004.

**M W Fried, M L Shiffman, K R Reddy, and others. Peginterferon alfa-2a plus ribavirin for chronic hepatitis C virus infection. New England Journal of Medicine 347(13): 975-982. September 26, 2002.

 

 

 

 

 

 

 


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