Response to Pegylated Interferon plus Ribavirin in HIV-HCV Coinfected Patients
with HCV Genotype 4
It
is well known that people with hepatitis
C virus (HCV) genotype 1 do not respond as well to interferon-based
therapy as those with genotypes
2 or 3. But genotype
4 -- the predominant type in the Middle East and parts of Africa -- has been
less extensively studied. Even less in known about genotype 4 in the HIV-HCV
coinfected population.
Many clinical trials combine genotypes 1 and
4 into a "harder to treat" category, but since genotype 4 is relatively
uncommon in industrialized countries where most studies are conducted, the results
mainly reflect outcomes for genotype 1 patients.
As reported in the October
2008 Journal of Viral Hepatitis, L. Martin-Carbonero from Hospital Carlos
III in Madrid, Spain, and colleagues retrospectively analyzed data from all genotype
4 patients treated with pegylated interferon
plus ribavirin in 2 multicenter studies, PRESCO
in Spain and ROMANCE in Italy.
The analysis included a total of 75 patients
(60 men, 15 women). The median age was 40 years, the median CD4 count was 598
cells/mm3, and 49% had plasma HIV viral loads < 50 copies/mL. The median serum
HCV RNA level was 5.7 log IU/mL. Nearly three-quarters (71%) had elevated liver
enzyme levels and 31% had advanced liver
fibrosis (Metavir stage F3-F4).
Baseline plasma HCV RNA levels, proportions
of patients achieving HCV RNA < 10 IU/mL at week 4 (rapid
virological response or RVR), and HCV RNA decline > 2 logs at week 12 (early
virological response or EVR) were assessed as predictors of continued undetectable
HCV RNA 24 weeks after the end of treatment (sustained virological response or
SVR).
Results
•
10 patients (20%) experienced RVR at week 4.
•
26 patients (42%) achieved EVR at week 12.
•
In an intent-to-treat analysis, 21 of 75 patients (28%) achieved SVR.
•
Using an on-treatment analysis, 21 of 62 (34%) achieved SVR.
•
In a multivariate analysis of the on-treatment group, baseline HCV RNA (odds ratio
[OR] 0.09 for every 1 log increment) and EVR (OR 7.08) were significantly and
independently associated with SVR.
"This
is the largest series of HIV-infected patients
with chronic hepatitis C due to HCV [genotype]
4 treated with pegylated interferon plus ribavirin examined so far, and the results
show that HCV [genotype] 4 behaves similarly to HCV genotype] 1," the study
authors wrote in conclusion.
Therefore, they added, "these patients
should be considered as [a] difficult to treat population."
Finally,
they noted that "Baseline serum HCV RNA and EVR are the best predictors of
SVR" in HIV/HCV genotype 4 coinfected patients.
10/21/08
Reference
L
Martin-Carbonero, M Puoti, J Garcia-Samaniego, and others. Response to pegylated
interferon plus ribavirin in HIV-infected patients with chronic hepatitis C due
to genotype 4. Journal of Viral Hepatitis 15(10): 710-715. October 2008.
(Abstract).
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