Effect of NRTI-sparing Antiretroviral Regimens on Outcomes of Hepatitis C Treatment

HIV-HCV coinfected patients taking AZT (Retrovir) are at higher risk for anemia during hepatitis C treatment with interferon plus ribavirin, since AZT and interferon can damage the bone marrows (where new red blood cells are produced) and ribavirin can cause red blood cell destruction.

In a study presented at the 46th ICAAC, held last week in San Francisco, German researchers sought to determine whether patients taking antiretroviral regimens that did not include nucleoside analog reverse transcriptase inhibitors (NRTIs) were likely to achieve better responses to hepatitis C treatment.

In this multicenter, prospective clinical trial, 103 participants were enrolled:

Group A: HIV negative subjects with HCV (n = 45);

Group B: HIV-HCV coinfected patients not receiving HAART (n = 27);

Group C1: HIV-HCV coinfected patients on NRTI-free HAART (n = 15);

Group C2: HIV-HCV coinfected patients on NRTI-containing HAART (n = 16);

Use of ddI (Videx) was not permitted, and use of AZT (Retrovir) was not recommended. All participants were treated with pegylated interferon alfa-2a (Pegasys) plus weight-based ribavirin.

Results

Most subjects were men, with a mean age of 40 years. HCV genotype distribution was 1 (48%), 2 (6%), 3 (38%), 4 (3%), and double infection (5%).

24 weeks after the completion of therapy, 51% of patients overall achieved sustained virological response (undetectable HCV RNA), broken down as follows:

- Group A: 62%;
- Group B: 41%;
- Group C1: 40%;
- Group C2: 44%.

In a binary logistic regression analysis, having genotype 1 or 4 HCV was associated with poorer response (P = 0.001).

HIV infection status influence had no apparent influence on treatment outcome (P = 0.137).

Sub-analysis of HIV positive patients did not reveal a significant influence of HAART (P = 0.238) or use of NRTIs (P = 0.270) on SVR rates.

Conclusion

"High SVR rates were reached in 41% of HIV positive patients," the researchers concluded. "[NRTI-free] HAART did not result in higher SVR rates."

Bonn Univ., Bonn, Germany; Practice Ctr. Kaiserdamm, Berlin, Germany; Practice Gute/Locher/Lutz, Frankfurt, Germany; Charite, Berlin, Germany; Univ. of Frankfurt, Frankfurt, Germany; Ärzteforum Seestrasse, Berlin, Germany; Practice Dupke/Carganico/Baumgarten, Berlin, Germany; Univ. of Hamburg, Hamburg, Germany; Klinikum Kemperhof, Koblenz, Germany; Grindelpraxis, Hamburg, Germany; Practice John, Berlin, Germany; Univ. of Ulm, Ulm, Germany; Univ. of Würzburg, Würzburg, Germany.

10/03/06

Reference
A Ahlenstiel, M Vogel, G Klausen, and others. The Influence of Nucleoside Free Haart on the Treatment of Chronic Hepatitis C with Pegylated Interferon / Ribavirin Combination Treatment. 46th ICAAC. San Francisco, CA. September 27-30, 2006. Abstract H-1886.

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