Coinfection

Hepatitis C Treatment Adherence Is Important for HIV/HCV Coinfected People

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Near-perfect adherence to pegylated interferon plus ribavirin offers the best chance of sustained virological response -- or a cure -- for HIV positive people coinfected with hepatitis C virus (HCV), according to a U.S. veterans study described in the August 21, 2012, advance online edition of AIDS and Behavior.

HIV/HCV coinfected individuals tend to experience more rapid liver disease progression and respond less well to interferon-based therapy than people with hepatitis C alone. The advent of direct-acting anti-HCV agents such as the protease inhibitors boceprevir (Victrelis) and telaprevir (Incivek) offer the prospect for shorter and more effective therapy -- eventually without interferon and its difficult side effects -- but coinfected people with progressive liver disease may not have much time to wait.

Vincent Lo Re from the University of Pennsylvania Perelman School of Medicine and colleagues looked at the effects of adherence to the outgoing standard-of-care treatment for chronic hepatitis C in people with HIV. Pegylated interferon stimulates the body's natural immune response to HCV, while ribavirin helps prevent relapse after completing therapy.

This retrospective cohort analysis included 333 HIV/HCV coinfected participants receiving care through the Department of Veterans Affairs medical system. Almost all (98%) were men, about half were white, and 45% were black. Most (80%) had difficult-to-treat HCV genotypes 1 or 4. 90% were on antiretroviral therapy for HIV and 6% were receiving methadone to manage opiate addiction.

Between 2001 and 2006, participants were treated with once-weekly pegylated interferon plus daily ribavirin for 48 weeks. They had available HCV RNA measurements from before and after treatment, and adherence was estimated over 12-week intervals using pharmacy refill information.

Results

"Among HIV/HCV patients, EVR and SVR increased with higher interferon and ribavirin adherence," the study authors concluded. "Adherence to both antivirals declined over time, but more so for ribavirin."

"Future studies should examine additional risk factors for non-adherence and evaluate interventions to maximize adherence to HCV therapy in this population," they recommended. "[I]dentifying suboptimal adherence using pharmacy refill records might allow clinicians to counsel patients to improve their adherence during therapy."

10/16/12

Reference

V Lo Re, V Teal, AR Localio, et al. Adherenceto Hepatitis C Virus Therapy in HIV/Hepatitis C-Coinfected Patients. AIDS and Behavior. August 21, 2012 (Epub ahead of print).