HIV
and Hepatitis.com Coverage of the 4th IAS Conference on HIV Pathogenesis, Treatment and Prevenion (IAS 2007) |
| Response
to Treatment of Acute Hepatitis C in HIV-HCV Coinfected Patients Two
studies presented at the 4th International AIDS Society Conference on HIV Pathogenesis,
Treatment and Prevention, taking place this week in Study 1 In
the first study, researchers examined the natural history and treatment of acute
hepatitis C in more than 200 participants in the Australian Trial of Acute Hepatitis
C (ATAHC). Among the 124 ATAHC subjects enrolled to date, 27 (22%) are HIV positive,
of whom 22 (81%) elected to undergo treatment with pegylated
interferon plus ribavirin for 24 weeks; 18 of these
had at least 24 weeks of follow-up data. While
the duration of standard treatment for chronic hepatitis C is 24 weeks for patients
with genotypes 2 or 3 HCV and 48 weeks for patients with genotype 1, past data
suggest that 24 weeks may be adequate for acute (recent) infection, regardless
of genotype. Among
these 18 subjects, all were men, with a mean age of 39 years. The median nadir
CD4 cell count was 377 cells/mm3, 94% had CDC class A HIV disease,
and 10 of the 18 (56%) were on HAART. About
two-thirds (67%) had HCV genotype 1a or 1b, while 28% had genotype 3. The mean
HCV viral load at baseline was 5.3 x 106 copies/ml. Risk factors for
HCV infection were injection drug use (39%) and sexual contact among men who have
sex with men (61%). In 55% of presumed sexually acquired cases, the partner was
known to be infected with HCV. The median estimated duration of infection before
starting treatment was 28 weeks (range 9-93). Results
“Treatment
for acute hepatitis C in HIV positive subjects is safe and highly effective,”
the researchers concluded. “This excellent response rate is despite a high proportion
of genotype 1 patients in whom treatment for chronic HCV is less than 50% successful.” National Centre In HIV Epidemiology
and Clinical Research, University of New South Wales, Sydney, Australia; Macfarlane
Institute for Medical Research and Public Health, and The Royal Melbourne Hospital,
Melbourne, Australia; Royal Melbourne Hospital, Mebourne, Australia, 4407 Doctors, Sydney, Australia; Holdsworth House Primary Care Practice, Sydney, Australia;
Virology Division, SEALS Microbiology, Prince of Wales Hospital, Sydney, Australia;
School of Medical Sciences, UNSW, Sydney, Australia. Study 2 In
the second study, researchers evaluated response to anti-HCV therapy and prognostic
factors in HIV positive patients with acute HCV infection. The analysis included
161 HIV positive men who were enrolled during outbreaks observed in Acute
HCV was defined as a positive HCV RNA or HCV antibody seroconversion
within 12 months after a negative HCV RNA PCR test, negative HCV antibody test,
or normal transaminase (ALT and AST) levels. Participants
were tested for HCV infection because they had abnormal liver function tests (n=106),
typical symptoms of acute hepatitis C (n=29), or were screen after engaging in
high-risk behaviors (n=26). The median age was 38 years. Most subjects (68%) had
genotype 1 HCV, while
13% had genotypes 2 or 3. At
the time of acute HCV diagnosis, 109 patients (70%) were receiving HAART,
80% of patients had HIV viral loads < 400 copies/ml, and the median CD4 count
was 444 cells/mm3. Anti-HCV
treatment consisted of conventional interferon monotherapy
(n=2), conventional interferon plus ribavirin (n=24),
pegylated interferon monotherapy
(n=17), or pegylated interferon plus ribavirin (n=118). Most patients (90%) started anti-HCV treatment
within 6 months of presumed infection (median 9 weeks). The median duration of
treatment was 24 weeks. The primary efficacy endpoint was SVR, or undetectable
plasma HCV RNA 24 weeks after Results
“In
acute HCV infection, interferon therapy was leading to a SVR rate of 64%,” the
investigators concluded. “Prognostic factors for sustained response were Hopital Pitié-Salpétrière, Service des Maladies Infectieuses, Paris, France; Chelsea and Westminster Hospital,
London, UK; University of Bonn, Germany; Royal Free Hospital, London, UK; Hopital
Pitié-Salpétrière, Service d'hépatogastroentérologie,
Paris, France; INSERM U720, Paris, France. |
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