Lower CD4 Count Predicts Slow HCV Decline and Poor Response to Pegylated Interferon plus Ribavirin in HIV/HCV Coinfected People

		SUMMARY: HIV/HCV coinfected patients experienced a smaller decrease in HCV RNA than HCV monoinfected individuals during the first-phase of decline after starting interferon-based therapy, and among coinfected patients, those with lower CD4 cell counts had slower HCV decline. These results, published in the December 2009 Journal of Acquired Immune Deficiency Syndromes, suggest that immune status plays an important role in treatment response.

By Liz Highleyman

Past research has shown that HIV/HCV coinfected people tend to experience more rapid liver disease progression and do not respond as well to interferon-based therapy as those with HCV alone. However, some evidence indicates that coinfected patients with well-preserved immune function may fare nearly as well as HCV monoinfected individuals.

To further explore this issue, Avidan Neumann from Bar-Ilan University in Israel and colleagues assessed the influence of CD4 T-cell count on HCV viral kinetics -- or pattern of change -- and treatment outcomes in coinfected patients.

The investigators compared HCV viral load kinetics among 32 HIV/HCV coinfected study participants and 12 HCV monoinfected patients treated with 1.5 mcg/kg/week pegylated-interferon alfa-2b (PegIntron) plus 1000-1200 mg/day weight-adjusted ribavirin for 48 weeks.

Results

	Having a baseline CD4 count >450 cells/mm3 was significantly associated with sustained virological response (SVR) in coinfected genotype 1 patients (P < 0.002).
	First-phase HCV RNA decline was significantly less among coinfected patients with low as compared with high CD4 counts (P < 0.03).
	First-phase HCV decline was also reduced among HIV/HCV coinfected compared with HCV monoinfected individuals (P < 0.002).
	The slope of second-phase HCV decline showed a similar trend for coinfected patients.

Based on these findings, the researchers concluded, "Low baseline CD4+ T-cell count is associated with slower HCV viral kinetics and worse response to treatment among HIV coinfected patients, suggesting HCV treatment response depends on immune status."

"HCV genotype 1 coinfected patients have slower first phase viral kinetics than HCV monoinfected patients," they continued. "First phase viral decline (> 1.0 log) and second phase viral decline slope (> 0.3 log/week) are excellent predictors of SVR for coinfected patients."

Bar-Ilan University, Ramat-Gan, Israel.

1/05/10

Reference

NU Avidan [aka Neumann AU], D Goldstein, L Rozenberg, and others. Hepatitis C Viral Kinetics During Treatment With Peg IFN-alpha-2b in HIV/HCV Coinfected Patients as a Function of Baseline CD4+ T-Cell Counts. Journal of Acquired Immune Deficiency Syndromes 52(4): 452-458 (Abstract). December 2009.