Factors that Predict Sustained Response to Hepatitis C Treatment in HIV-HCV Coinfected Individuals

By Liz Highleyman

Several studies have shown that HIV-HCV coinfected people do not respond as well to interferon-based treatment as those with hepatitis C alone, though the reasons for this are not well understood.

As reported in the July 31, 2007 issue of AIDS, an international team of researchers performed a study to identify baseline characteristics that predict sustained virological response (SVR, or undetectable HCV RNA 24 weeks after the completion of treatment) in HIV-HCV coinfected patients treated with interferon-based therapy.

The analysis included 853 coinfected subjects from the pivotal AIDS PEGASYS Ribavirin International Coinfection Trial (APRICOT), which compared treatment with pegylated interferon alfa-2a (Pegasys) plus ribavirin, conventional interferon plus ribavirin, or pegylated interferon monotherapy. Among patients receiving pegylated interferon plus ribavirin, the SVR rates were 29% for people with HCV genotype 1 and 62% for those with genotypes 2 or 3.

Results

• Overall, in addition to type of anti-HCV therapy, the factors most predictive of SVR were:

- baseline HCV RNA (? vs > 400,000 IU/ml; odds ratio 4.77; P < 0.0001).

- HCV genotype (odds ratio 2.87; P < 0.0001).

• Other weaker predictors were:

- antiretroviral treatment for HIV using a protease inhibitor or non-nucleoside reverse transcriptase inhibitor (P = 0.034);

- race, with people of African descent responding more poorly to interferon (P = 0.027);

- body mass index (P = 0.039).

Conclusion

In the APRICOT study, the authors concluded, "the predictors of SVR among HIV-HCV coinfected patients treated with peginterferon alfa-2a plus ribavirin were similar to those in patients with HCV monoinfection. The HCV genotype and pretreatment HCV RNA level had the greatest influence on SVR."

08/31/07

Reference
GJ Dore, FJ Torriani, M Rodriguez-Torres, and others. Baseline factors prognostic of sustained virological response in patients with HIV-hepatitis C virus co-infection. AIDS 21(12): 1555-1559, July 31, 2007.