Rapid Response to Hepatitis C Treatment Predicts Cure, but Occurs Less Often in HIV-HCV Coinfected Patients

By Liz Highleyman

Rapid virological response (RVR) to interferon-based treatment for hepatitis C, or HCV RNA below 50 IU/mL at Week 4 of therapy, predicts eventual sustained virological response (SVR) -- or "cure" -- in HIV negative individuals with hepatitis C.

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 study to assess the incidence, determinants, and predictive value of RVR in HIV-HCV coinfected patients with genotype 3 HCV.

The investigators analyzed longitudinally gathered data from 161 coinfected genotype 3 patients who received combination anti-HCV therapy for at least 12 weeks at 3 centers in Italy. 173 HIV negative hepatitis C patients served as controls.

Results

• RVR was observed in 43% of the HIV-HCV coinfected patients, compared with 80% of HCV monoinfected subjects.

• In coinfected subjects, RVR was independently associated with baseline GGT above the upper limit of normal and a daily ribavirin dose > 13 mg/kg.

• Even after adjusting for other covariates, HIV-HCV coinfection was independently associated with a lower RVR rate (P = 0.0003).

• Among the coinfected patients, 74% with RVR and 34% without RVR went on to achieve SVR (P < 0.0001).

• RVR was associated with SVR even after adjusting for other covariates.

• The SVR rate was significantly higher in HCV monoinfected subjects with RVR (96%).

• HIV-HCV coinfection was independently associated with a lower rate of SVR in patients with RVR after adjusting for other covariates (P = 0.01).

Conclusion

In conclusion, the researchers wrote, "RVR is a strong predictor of a favourable treatment outcome in HIV-HCV coinfected persons with HCV [genotype] 3, however HIV coinfection decreases its frequency and its predictive value [for] SVR."

University of Brescia, Infectious Diseases, Brescia, Italy; Ospedali Riuniti, Infectious Diseases, Bergamo, Italy; University of Modena, Infectious Diseases, Modena, Italy.

08/21/07

Reference
P Pagani, M Puoti, GP Quinzan, and others. Rapid virologic response during combination anti HCV treatment in HIV co-infected patients with HCV genotype 3: predictors and clinical significance in comparison with HIV uninfected persons. 4th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention. Sydney, Australia, July 22-25, 2007. Abstract MOPEB047.