Histological Response to Pegylated Interferon plus Ribavirin in HIV-HCV Coinfected Individuals

By Liz Highleyman

APRICOT (AIDS Pegasys Ribavirin International Coinfection Trial) was a pivotal study that demonstrated the superior efficacy of 180 mcg/week pegylated interferon alfa-2a (Pegasys) plus 800 mg/day ribavirin for 48 weeks compared with Pegasys monotherapy or conventional interferon alpha-2a plus ribavirin in HIV-HCV coinfected patients (sustained virological response [SVR] rates of 40%, 20%, and 12%, respectively).

As reported in the November 2006 issue of AIDS, researchers analyzed paired liver biopsies from patients enrolled in APRICOT to investigate whether virological response was associated with histological response (improved liver tissue health).

A total of 860 coinfected patients were included in the trial as a whole, of whom 401 had paired biopsy results. Biopsies were scored locally using the Ishak-modified histological activity index (HAI). The second biopsy was obtained an average of 26 weeks or more after the end of treatment. Histological response was defined as a 2-point or greater reduction in HAI score.

Results

The histological response rate was significantly higher among patients receiving Pegasys plus ribavirin (57%) than among those receiving Pegasys plus placebo or (39%; P < 0.017) or conventional interferon plus ribavirin (41%; P = 0.04).

Histological response was correlated with virological response, with the histological response rate ranging from 62% to 74% among patients who achieved SVR.

Histological response was also observed in 32%-43% of patients who did not achieve SVR.

A higher total HAI score was the only prognostic factor for achieving histological response.

Conclusion

The histological response rate was significantly higher in HIV-HCV coinfected patients who received [Pegasys] plus ribavirin than in those receiving [Pegasys] plus placebo or [conventional interferon alpha-2a] plus ribavirin," the authors concluded. "Histological response was correlated with virological response, although a substantial proportion of patients who did not achieve an SVR experienced histological improvement."

11/7/06

References

E Lissen, N Clumeck, R Sola, and others. Histological response to pegIFN-alpha-2a (40KD) plus ribavirin in HIV-hepatitis C virus co-infection. AIDS 20(17): 2175-2181. November 2006.

V Soriano, P Labarga, A Ruiz-Sancho, and others. Regression of liver fibrosis in hepatitis C virus/HIV-co-infected patients after treatment with pegylated interferon plus ribavirin [Editorial comment]. AIDS 20(17): 2225-2227. November 2006.