HCV
Viral Load Decline during First 48 Hours of Pegylated
Interferon plus Ribavirin in HCV Monoinfected and
HCV/HIV Coinfected Patients
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| SUMMARY:
A recent Dutch study found that among HIV
negative patients with chronic hepatitis
C virus (HCV) infection -- but not HIV/HCV
coinfected individuals -- those with larger
and steeper decreases in HCV viral load
within the first 48 hours of treatment with
pegylated interferon plus ribavirin were
more likely to achieve rapid virological
response (RVR) at week 4. The study, published
in the December 2009 Journal of Viral
Hepatitis, also showed that 48-hour
response was a predictor of sustained virological
response (SVR) in both HCV monoinfected
and coinfected participants. |
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By
Liz Highleyman
During
treatment with pegylated
interferon plus ribavirin, plasma HCV RNA decreases
with a rapid first phase and a slower second phase,
the study authors noted as background.
In
this analysis, the researchers compared the magnitude
(size) and slope (speed or rate) of viral load decline
during the first 48 hours of treatment with pegylated
interferon alfa-2a (Pegasys) plus ribavirin in
patients who did and did not achieve RVR, defined
as undetectable HCV RNA (< 50 IU/mL) at week 4.
The
study included 23 patients with genotype 1 or 4 HCV
(14 monoinfected and 9 HIV/HCV coinfected). Plasma
HCV RNA was measured at baseline, at 48 hours, and
at weeks 1, 2, 4, 8, 12, 48, and 72. HCV viral load
decrease, slope of the decrease, and the efficiency
factor (epsilon) were determined in the first 48 hours
after the start of therapy.
Results
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5
HCV monoinfected participants (36%) and 3 HIV/HCV
coinfected patients (33%) attained RVR at week
4. |
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6
monoinfected patients (43%) and 5 coinfected patients
(56%) achieved SVR at 24 weeks after completion
of therapy. |
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The
5 HCV monoinfected participants who attained RVR
demonstrated both a larger decrease in HCV viral
load and a steeper slope (faster decline) compared
to the 9 monoinfected patients without RVR. |
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HCV
RNA change: 1.77 vs 0.66 log10 IU/mL, respectively
(P = 0.019); |
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HCV
RNA slope: 2.04/day vs 0.76/day, respectively
(P = 0.019). |
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Among
the coinfected participants, however, a significant
association between HCV RNA decline at 48 hours
and RVR was not observed. |
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When
looking at participants who achieved SVR, larger
HCV RNA decline and steeper slope at 48 hours
were seen in both HCV monoinfected and HIV/HCV
coinfected patients. |
Based on these findings, the study authors concluded,
"in the first 48 hours after the start of therapy,
HCV monoinfected patients with an RVR have a larger
viral load decrease, steeper viral slope, and a higher
efficiency factor as compared with non-RVR patients."
Early
response at week 12 is commonly used to decide whether
patients can stop interferon-based treatment that
is unlikely to produce a sustained response. Numerous
studies have shown that RVR at week 4 is also a good
predictor of SVR. This study suggests that even very
early response at 48 hours may be a predictive factor,
at least among HCV monoinfected patients.
Departments
of Internal Medicine and Infectious Diseases, Medical
Microbiology, Gastroenterology, and Immunology, University
Medical Center Utrecht, Utrecht, Netherlands; Department
of Gastroenterology, Onze Lieve Vrouwe Gasthuis, Amsterdam,
Netherlands; Department of Internal Medicine and Infectious
Diseases, Erasmus Medical Center, Rotterdam, Netherlands.
12/4/09
Reference
JE
Arends, JC Stuart, LC Baak, and others. Plasma HCV-RNA
decline in the first 48 h identifies hepatitis C virus
mono-infected but not HCV/HIV-coinfected patients
with an undetectable HCV viral load at week 4 of peginterferon-alfa-2a/ribavirin
therapy. Journal of Viral Hepatitis 16(12):
867-875. December 2009. (Abstract).
