HIV and Hepatitis.com Coverage of the 15th
Conference on Retroviruses and Opportunistic Infections (CROI 2008) February
3 - 6, 2008, Boston, MA
The
material posted on HIV and Hepatitis.com about CROI 2008 is not approved by
nor is it a part of CROI 2008.
Race,
but Not HIV Status, Affects Early Hepatitis C Viral Kinetics
Research
has conclusively established that people of African descent tend to respond less
well than Caucasians to interferon-based
therapy for hepatitis C. Several studies have shown that HIV
positive people coinfected with HCV also tend to respond more poorly than
HIV negative individuals, but some data indicate that coinfected people with well-controlled
HIV, well-preserved immune function, and receiving adequate doses of ribavirin
may do as well as those with HCV alone.
Wilcoxon
Rank Sum test was used to compare early viral kinetics parameters between Caucasians
and African Americans and between HIV positive and negative individuals. A 2-way
analysis of variance using rank transformed data was performed to assess whether
there is an interaction between race and HIV status for the viral kinetic parameters.
Results
•
In the HIV-HCV coinfected Caucasian group,
6 patients relapsed or had no response, 3 achieved SVR, and 4 were still on treatment.
•
In the coinfected African American group,
6 relapsed or were non-responders and 1 was still on therapy.
•
In the HCV monoinfected Caucasian group, 3
relapsed or had no response, 3 achieved SVR, and 1 discontinued therapy prematurely.
•
In the HCV monoinfected African American group,
2 relapsed and 2 were still on treatment.
•
Overall, 3 of 9 HIV negative individuals (33%)
and 3 of 15 HIV-HCV coinfected patients achieved SVR.
•
Among Caucasians, 6 of 16 (38%) achieved SVR,
compared with none of the 8 African Americans who completed treatment.
•
No difference in HCV RNA level at baseline
was seen between the African American and Caucasian groups.
•
However, the Caucasian group had a faster
first-phase decline in HCV RNA from baseline to day 3 (0.75 vs. 0.29 log; P =
0.02).
•
Second-phase slope was also faster in the
Caucasian group (0.38 vs 0.23 log; P = 0.06).
•
No differences were observed in first or second
phase decline in the HIV-HCV coinfected compared with the HCV monoinfected group.
•
No interaction between HIV status and race
was found in viral kinetic parameters.
Conclusion
"Early
viral kinetics, as measured by HCV RNA decline, was slower in African American
[patients] in both first and second phases, which may explain lower SVR rates;
but first and second phase decline were similar in both HIV positive and negative
patients," the investigators concluded.
Thus, they continued, "response
to interferon, measured by early HCV RNA decline, appears different in African
Americans but similar between those with HIV infection and those without."
Finally,
they added, "Lower SVR rates seen in the HIV [positive] population may be
due to impaired late immune clearance of HCV or [a] higher proportion of African
Americans with HIV-HCV [coinfection]. Different treatment strategies are needed
to improve responses for African Americans and HIV-HCV coinfected patients."
Univ
of Texas Southwestern Med Ctr, Dallas, TX; Univ of Washington, Seattle, WA.
Race,
but Not HIV Status, Affects Early Hepatitis C Viral Kinetics
Research
has conclusively established that people of African descent tend to respond less
well than Caucasians to 
Results
