Elevated blood levels of low-density lipoprotein (LDL
or "bad") cholesterol has also been linked to improved treatment response
in HCV monoinfected individuals, possibly because
the LDL receptor plays a role in HCV entry into host cells. Now, as reported in
the May 11, 2008 issue of AIDS, researchers have found that high LDL also
predicts better outcomes in HIV-HCV
coinfected patients.
Spanish
investigators conducted a retrospective analysis of 260 HIV-HCV coinfected participants
(80% men; mean age 40 years) who had available baseline serum lipid profile data.
About half (53%) had HCV genotype 1, 39% had genotype 3, and 8% had genotype 4.
Participants had well controlled HIV disease, with a mean CD4 count of 520 cells/mm3.
All were treated with pegylated interferon plus 800-1400 mg/day ribavirin
for 24 or 48 weeks (depending on genotype); non-responders discontinued therapy
early. None were taking lipid-lowering agents to manage high cholesterol.
Results
•
Overall, 38
patients (24%) with genotypes 1 or 4, and 64 patients (63%) with genotypes 2 or
3 achieved sustained virological response (SVR), or continued undetectable HCV
RNA 24 weeks after completion of therapy.
•
49 patients
(44%) with serum LDL levels of 100 mg/dl or higher achieved SVR, compared with
53 (36%) with lower LDL values (adjusted odds ratio 2.51; P = 0.003).
•
Other predictors
of SVR were infection with HCV genotypes 2 or 3 (vs 1 or 4), baseline HCV RNA
of 600,000 IU/ml or less, and exposure to at least 80% of the planned anti-HCV
therapy.
•
Absence of
concomitant antiretroviral therapy for HIV also predicted SVR.
•
The association
between LDL and treatment response was independent of these other predictors of
response.
•
The SVR rate
for genotype 1 patients with LDL of 100 mg/dl or higher was 31%, compared with
17% for those with lower values (adjusted odds ratio 2.19; P = 0.040).
•
The corresponding
rate for patients with genotypes 2 or 3 were 73% and 58%, respectively (adjusted
odds ratio 2.71; P = 0.054).
•
Levels of other
blood lipids - including high-density lipoprotein (HDL or "good") cholesterol
and triglycerides - were not associated with treatment response.
Conclusion
Based
on these findings, the investigators concluded that, "Higher low-density
lipoprotein cholesterol levels predict sustained virologic response to pegylated
interferon and ribavirin in HIV/hepatitis C virus coinfected patients. This
might be used to improve the rate of sustained virologic response in this setting."
5/23/08
Reference J
del Valle, J Mira, I de los Santos, and others. Baseline serum low-density lipoprotein
cholesterol levels predict response to hepatitis C virus therapy in HIV/hepatitis
C virus coinfected patients. AIDS. 22(8): 923-930. May 11, 2008.
Spanish
investigators conducted a retrospective analysis of 260 HIV-HCV coinfected participants
(80% men; mean age 40 years) who had available baseline serum lipid profile data.
About half (53%) had HCV genotype 1, 39% had genotype 3, and 8% had genotype 4.
Participants had well controlled HIV disease, with a mean CD4 count of 520 cells/mm3.
