Positive and Negative Individuals with Acute or Early Chronic Hepatitis C Respond
Well to 24 Weeks of Pegylated Interferon plus Ribavirin
the early 2000s, clinicians in the U.K. and elsewhere in Europe have reported
outbreaks of apparently sexually transmitted acute
hepatitis C virus (HCV) infection, mostly among HIV
positive men who have sex with men (MSM). More recently, similar cases have
been reported in the U.S., and one research team has found that liver
disease may progress very rapidly in people who already have HIV at the time
of HCV infection.
hepatitis C responds very well to interferon-based treatment started during the
acute or even early chronic stage, according to a study published in the March
1, 2009 issue of Clinical Infectious Diseases.
Gail Matthews of
the University of New South Wales in Sydney and colleagues described findings
from the Australian Trial in Acute Hepatitis C (ATAHC), a National Institutes
of Health-funded prospective cohort study of the natural history and efficacy
of treatment of early HCV infection. Both HIV positive and HIV negative individuals
were eligible for the study; of the initial 103 patients enrolled, 27 (26%) were
HIV positive people receiving antiretroviral
therapy typically undergo regular liver function monitoring to assess drug
toxicity. Unexplained liver enzyme elevations may signal acute HCV infection.
HIV negative people, however, seldom receive regular HCV screening or liver enzyme
monitoring, so acute HCV infection -- which is often asymptomatic -- is likely
to go unnoticed.
Eligible ATAHC participants had a first positive anti-HCV
antibody test within 6 months prior to enrollment, and had either clinical hepatitis
diagnosed within the past 12 months or documented anti-HCV seroconversion within
the past 24 months.
Treated participants received pegylated
interferon plus ribavirin for 24 weeks. The standard duration of therapy for
chronic hepatitis C is 24 weeks for patients with genotype
2 or 3 and 48 weeks for those with genotype
1, though 48 weeks is usually recommended for HIV positive patients regardless
of genotype. Acute HCV infection responds better to treatment, however, and studies
have shown that 24 weeks is generally sufficient.
Compared with HIV negative individuals, HIV positive patients were more likely
to be older, to have HCV genotype 1, and to have high a HCV RNA level at baseline.
Presumed sexual transmission accounted for the majority (56%) of HCV infections
among HIV positive patients, compared with only 8% among HIV negative participants.
The median duration from the estimated time of HCV infection to treatment initiation
was 30 weeks (acute infection is defined as the first 24 weeks).
Overall, 44% of patients treated with pegylated interferon plus ribavirin had
undetectable HCV RNA at week 4 (rapid virological response or RVR).
95% of patients had undetectable HCV RNA at week 12 (early virological response
90% had undetectable HCV viral load at 24 weeks (end of treatment response).
80% still had undetectable HCV RNA at week 48, or 24 weeks after the completion
of treatment (sustained virological response or SVR).
RVR at week 4 had a positive predictive value for SVR of 100% and a negative predictive
value of 33%.
on these findings, the study authors concluded, "Significant differences
were demonstrated between HIV-infected and HIV-uninfected individuals enrolled
"Treatment responses among HIV-infected individuals
with both acute and early chronic infection are encouraging and support regular
HCV screening of high-risk individuals and early treatment for recently acquired
HCV infection," they added.
Matthews, M Hellard, P Haber, and others. Characteristics and treatment outcomes
among HIV-infected individuals in the Australian Trial in Acute Hepatitis C. Clinical
Infectious Diseases 48(5): 650-658. March 1, 2009. (Abstract).