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 HIV and Coverage of the
th Annual Meeting of the American Association
for the Study of Liver Diseases
(AASLD 2009)

October 30 - November 3, 2009, Boston, MA

Pegylated Interferon plus Ribavirin Can Effectively Treat both Hepatitis B and C In Dually Infected Patients

SUMMARY: Combination therapy using pegylated interferon plus ribavirin produced both sustained hepatitis C virus (HCV) suppression and hepatitis B surface antigen (HBsAg) clearance in patients dually infected with both viruses, according to a study presented this month at the 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2009) in Boston.

By Liz Highleyman

Due to overlapping routes of transmission, many people are coinfected with both hepatitis B and C, a combination that increases the risk of liver disease progression.

Researchers from Taiwan previously found that HBV/HCV coinfected patients had a relatively high (11%) rate of HBsAg clearance 6 months after completing standard hepatitis C treatment using pegylated interferon alfa-2a (Pegasys) plus ribavirin; pegylated interferon is also an approved therapy for chronic hepatitis B. That study also showed that sustained virological response rates were similar in HCV monoinfected and HBV/HCV coinfected patients.

In the present analysis, the investigators sought to determine whether the rate of HBsAg clearance increased during long-term follow-up of coinfected patients in the initial study.

A total of 161 initially HBsAg positive patients with hepatitis C were treated with 180 mcg/week pegylated interferon alfa-2a plus 1000/1200 mg/day weight-adjusted ribavirin for 48 weeks if they had HCV genotype 1, or 800 mg/day ribavirin for 24 weeks if they had genotype 2 or 3. Of these participants, 108 were still available for follow-up 1.5 years after completing treatment.


1.5 years after completing hepatitis C therapy:
91 patients (84%) had undetectable HCV RNA;
51 patients (47%) had undetectable HBV DNA;
41 patients (38%) had undetectable levels of both viruses.
17 participants (16%) were considered to have cleared HBsAg, with levels < 0.05 IU/mL.
A majority of these patients (12 of 17) had HBsAg levels < 10 IU/mL at baseline.
9 of the 17 patients with HBsAg clearance also had undetectable HBV DNA (the remainder had HBV DNA < 2000 IU/mL) and 8 had sustained undetectable HCV RNA.
HBsAg clearance was observed in patients with HBV genotypes B and C.

Based on these findings, the investigators concluded, "Combination therapy of Pegasys and ribavirin is effective for treatment of patients dually infected with HCV and HBV and can result in successful treatment of both chronic viral infections."

They continued, "The high rates of HBsAg clearance -- the closest outcome to cure in chronic hepatitis B -- coupled with the similar sustained virologic response rates in HCV/HBV coinfection compared with HCV monoinfection, suggests that peginterferon alfa-2a and ribavirin combination therapy is an effective first-line treatment strategy for this patient group."

National Taiwan University College of Medicine, Taipei, Taiwan; Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Chang Gung Memorial Hospital-Kaohsiung, Kaohsiung, Taiwan; Changhua Christian Hospital, Changhua, Taiwan; Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan; Chi Mei Medical Center, Tainan, Taiwan; Tri-Service General Hospital, Taipei, Taiwan; Chai-Yi Chang Gung Memorial Hospital, Chiayi, Taiwan; Cathay General Hospital, Taipei, Taiwan.


C Liu, W Chuang, C Lee, and others. HBsAg clearance continues to increase post-treatment in patients with HCV/HBV coinfection treated with peginterferon alfa-2a plus ribavirin: 1.5 year follow-up. 60th Annual Meeting of the American Association for the Study of Liver Diseases (AASLD 2009). Boston. October 30-November 1, 2009. Abstract 419.


























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