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HIV Positive and Negative Individuals with Acute or Early Chronic Hepatitis C Respond Well to 24 Weeks of Pegylated Interferon plus Ribavirin

By Liz Highleyman

Since 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.

Fortunately, 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.

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.

Results

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 or EVR).

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%.

Based on these findings, the study authors concluded, "Significant differences were demonstrated between HIV-infected and HIV-uninfected individuals enrolled in ATAHC."

"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.

4/14/09

Reference
GV 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).