Coinfection

Ribavirin Helps Early Hepatitis C Treatment in People with HIV

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Adding ribavirin to pegylated interferon increases the likelihood of a cure for early hepatitis C virus (HCV) infection in people with HIV, according to study findings published in the May 2, 2012, advance online edition of AIDS.

If detected and treated during the acute or early stages of HCV infection, overall sustained response rates are very high with pegylated interferon alone. But HIV positive people typically do not respond as well to interferon and may need more intensive treatment for acute hepatitis C. Ribavirin is known to reduce the risk of post-treatment relapse and therefore raise the odds of a cure.

Jason Grebely from the University of New South Wales and colleagues with the Australian Trial in Acute HCV (ATAHC) Study Group evaluated early viral decline and sustained response to treatment of recent HCV infection in HIV negative people receiving pegylated interferon monotherapy and HIV positive people receiving pegylated interferon plus ribavirin for 24 weeks.

Results

  • Out of 109 patients treated, 82% (57 HCV monoinfected and 32 HIV/HCV coinfected) achieved at least 80% adherence and were considered in the final analysis.
  • HCV monoinfected people were somewhat more likely than coinfected participants to achieve rapid virological response (RVR) at week 4 of treatment, but the difference did not reach statistical significance:
    • HCV monoinfected: 55%;
    • HIV/HCV coinfected: 43%.
  • Adherent HCV monoinfected and HIV/HCV coinfected patients also had similar rates of early virological response at week 12:
    • HCV monoinfected: 79%;
    • HIV/HCV coinfected: 90%.
  • Sustained virological response (SVR) rates after completion of therapy were statistically similar as well:
    • HCV monoinfected: 63%;
    • HIV/HCV coinfected: 75%.
  • Factors independently associated with RVR included duration of infection less than 26 weeks, baseline HCV RNA < 5.6 log IU/mL, and having HCV genotype 2 or 3.
  • The average decline in HCV viral load through week 12 was significantly larger among coinfected participants receiving dual therapy than among HCV monoinfected people receiving pegylated interferon alone (4.19 vs 3.32 log IU/mL, respectively).
  • Greater HCV RNA decline was observed among patients who received ribavirin, especially those with longer estimated duration of infection and IL28B CT or TT gene patterns.
  • RVR was highly predictive of SVR.

Based on these findings, the study authors concluded, "The results of this study suggest a potential benefit for pegylated interferon and ribavirin combination therapy in maximizing virological responses in [HIV/HCV coinfected] participants with recent HCV, particularly those with a longer duration of HCV infection and unfavorable IL28B genotypes."

5/8/12

Reference

J Grebely, M Hellard, T Applegate, et al (ATAHC Study Group). Virological responses during treatment for recent hepatitis C virus: Potential benefit for ribavirin use in HCV/HIV co-infection. AIDS. May 2, 2012 (Epub ahead of print).