HIV and Hepatitis.com Coverage of the
4th IAS Conference on HIV Pathogenesis, Treatment and Prevenion (IAS 2007)
 July 22-25, 2007, Sydney, Australia

Pegylated Interferon plus Ribavirin Slows Liver Cirrhosis Progression in HIV-HCV Coinfected Individuals, Even if Non-responders

Research has shown that HIV-HCV coinfected individuals tend to experience more rapid liver disease progression than those with hepatitis C virus (HCV) monoinfection. While past studies have shown that among HCV monoinfected individuals, even non-responders to interferon-based therapy have reduced liver disease progression, the clinical impact of hepatitis C treatment on the rate of liver cirrhosis progression in coinfected non-responders is unknown.

As reported at the recent 4th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention in Sydney, Australia (July 22-25, 2007), Italian researchers conducted a retrospective longitudinal study of 25 HIV-HCV coinfected patients with cirrhosis who did not respond to treatment with pegylated interferon plus ribavirin. The median duration of anti-HCV therapy was 9 months (range 5-12).

A control group included 25 untreated coinfected subjects matched for age (within 5 years), sex, and Child-Pugh score. The treated and untreated patients were comparable in terms of alcohol intake, CDC HIV disease classification, use of HAART, and presence of esophageal varices.

The primary endpoint was the incidence of cirrhosis progression, defined as the occurrence of at least 1 of the following events: death, ascites, jaundice, encephalopathy, gastrointestinal bleeding, or hepatocellular carcinoma (HCC).

Results

  • During a median follow-up period of 54 months, 4 treated patients (16%) and 13 untreated control subjects (52%) experienced cirrhosis progression (P = 0.02).

  • The respective incidence rates were 7.7 and 65.1 per 100 person-years of follow-up.

  • Poisson’s regression model showed that the independent predictors of cirrhosis progression were:
    • Use of pegylated interferon therapy (adjusted relative risk [RR] 0.03);
    • Detectable HIV viral load (adjusted RR 35.98);
    • Altered ALP values (adjusted RR 25.5).

Conclusion

“Pegylated interferon therapy seems to slow down the rate of cirrhosis progression also in HIV-HCV coinfected patients [who were] non-responders to anti-HCV therapy, in comparison with untreated patients,” the researchers concluded.

San Raffaele Hospital, Scientific Institute, Vita-Salute University, Infectious diseases, Milan, Italy.

08/17/07

Reference
A De Bona, L Galli, G Gallotta, and others. Rate of cirrhosis progression reduced in HIV/HCV co-infected non-responders to anti-HCV therapy. 4th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention. Sydney, Australia, July 22-25, 2007. Abstract MOPEB049.