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 HIV and Hepatitis.com Coverage of the
49
th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2009)
September 12-15, 2009, San Francisco, CA
 The material posted on HIV and Hepatitis.com about the 49th ICAAC is not approved by the American Society for Microbiology
HCV Viral Load Decline during the First 24 Hours of Interferon-based Therapy Predicts Long-term Outcomes in HIV-HCV Coinfected Patients

Changes in hepatitis C virus (HCV) blood levels as early as 24 hours after starting treatment with pegylated interferon plus ribavirin are a strong negative predictor of sustained response in HIV positive individuals, according to an Argentinean study presented at the 49th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2009) this week in San Francisco. Individuals who did not begin to experience viral load decline during the first day of treatment were very unlikely to achieve sustained virological response (SVR).

By Liz Highleyman

Early virological response (EVR) to interferon-based therapy at week 12 and rapid virological response (RVR) at week 4 are known to predict SVR, or continued undetectable HCV RNA 6 months after completing therapy. Even earlier response has been shown to predict long-term outcomes in HCV monoinfected individuals, but there is little data for HIV-HCV coinfected patients.

The present analysis included 20 coinfected participants (17 of them men) treated with pegylated interferon plus ribavirin; 19 were also taking combination antiretroviral therapy (ART). Patients had well-controlled HIV disease overall, with a median CD4 count of 545 cells/mm3. Three-quarters had HCV genotype 1 and half had advanced liver fibrosis or cirrhosis (Metavir stage F4-F3).

Results

HCV viral load decline 24 hours after starting treatment was significantly higher among patients who went on to achieve SVR compared with eventual non-responders (1.6 vs 0.5 logs).
A decrease of less than 0.9 log at 24 hours was the best cut-off level for differentiating responders and non-responders.
The sensitivity of this cut-of value was 100% and the specificity was 82%.
This cut-off had a negative predictive value (NPV) for SVR of 100% and a positive predictive value (PPV) of 71%.

Based on these findings, the researchers concluded that, "patients who do not reach 0.9 log decay at 24 hours will not achieve SVR."

"These results suggest that in HIV-HCV coinfected patients HCV therapy could be guided [by] following very early changes in HCV viral load," they added, suggesting that this could allow optimization of treatment particularly in resource-limited settings, as well as for patients with pre-treatment predictors of non-response or severe toxicity.

Argentinean Reference Ctr. for AIDS, Buenos Aires, Argentina; Hosp. Juan A. Fernández, Buenos Aires, Argentina.

9/18/09

Reference
N Laufer, F Bolcic, E Socias, and others. Early Changes in HCV Viral Load During the First 24 Hours of Treatment Exhibit a Very High Negative Predictive Value of Sustained Virological Response in HCV/HIV Coinfected Patients. 49th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2009). San Francisco. September 12-15, 2009. Abstract H-213.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 



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