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Predicting which HIV/HCV-coinfected patients will respond to HCV treatment: some expected and some surprising answers
Patients who have an undetectable hepatitis C viral load within four weeks of the initiation of hepatitis C therapy are likely to be successfully treated for hepatitis C infection, according to a German study presented to the Fourth International Workshop on HIV and Hepatitis Coinfection in Madrid on June 20th. The investigators also found that stable HIV infection without a need for anti-HIV therapy predicted an undetectable hepatitis C viral load twelve weeks after starting anti-hepatitis C treatment.
Investigators in the western German cities of Bonn and Cologne wanted to determine the factors associated with successful hepatitis C therapy in HIV/hepatitis C-coinfected patients.
They therefore designed a retrospective study involving 227 individuals who received anti-hepatitis C therapy that included pegylated interferon and ribavirin.
Most of the patients were male (73%), the mean age was 41 years, and 59% of individuals were taking anti-HIV treatment. Average CD4 cell count at the initiation of anti-hepatitis C treatment was 531 cells/mm3, with average HIV viral load being a little over 11,000 copies/ml, reflecting the fact that over 40% of patients were not on antiretroviral therapy.
The most common hepatitis C genotype was the hard to treat genotype 1 (56%), with a further 7% of patients having infection with genotype 4, which is also associated with a poor response to anti-hepatitis C treatment.
Overall, 41% of patients achieved a sustained virological response. The investigators then looked at which factors predicted this outcome.
The first of the factors they identified was, as expected, infection with the easier to treat hepatitis C genotypes 2 and 3 (p < 0.001). They also found that a “rapid virological response” to anti-hepatitis C therapy – an undetectable hepatitis C viral load within four weeks of its initiation – was also associated with successful anti-hepatitis C therapy (p < 0.001), as was an “early virological response” – an undetectable hepatitis C viral load after twelve weeks of anti-hepatitis C treatment (p < 0.001).
When the investigators looked at factors associated with an early virological response, they found that these once again included infection with genotypes 2 and 3 (p < 0.001), a rapid virological response (p < 0.001), but also a lack of antiretroviral therapy (p = 0.043).
The investigators were surprised by this final finding. But they said that patients with high CD4 cell counts, and therefore no need to take anti-HIV treatment, were therefore able to avoid the possible liver-toxic interactions between antiretroviral and anti-hepatitis C drugs, increasing the chances of their livers clearing hepatitis C infection.
Reference
Janke M. et al. Which factors predict early and sustained virological response under combination hepatitis C therapy in HIV/HCV co-infected patients? Fourth International Workshop on HIV and Hepatitis Coinfection, Madrid, abstract 14, 2008.
Investigators in the western German cities of Bonn and Cologne wanted to determine the factors associated with successful hepatitis C therapy in HIV/hepatitis C-coinfected patients.
They therefore designed a retrospective study involving 227 individuals who received anti-hepatitis C therapy that included pegylated interferon and ribavirin.
Most of the patients were male (73%), the mean age was 41 years, and 59% of individuals were taking anti-HIV treatment. Average CD4 cell count at the initiation of anti-hepatitis C treatment was 531 cells/mm3, with average HIV viral load being a little over 11,000 copies/ml, reflecting the fact that over 40% of patients were not on antiretroviral therapy.
The most common hepatitis C genotype was the hard to treat genotype 1 (56%), with a further 7% of patients having infection with genotype 4, which is also associated with a poor response to anti-hepatitis C treatment.
Overall, 41% of patients achieved a sustained virological response. The investigators then looked at which factors predicted this outcome.
The first of the factors they identified was, as expected, infection with the easier to treat hepatitis C genotypes 2 and 3 (p < 0.001). They also found that a “rapid virological response” to anti-hepatitis C therapy – an undetectable hepatitis C viral load within four weeks of its initiation – was also associated with successful anti-hepatitis C therapy (p < 0.001), as was an “early virological response” – an undetectable hepatitis C viral load after twelve weeks of anti-hepatitis C treatment (p < 0.001).
When the investigators looked at factors associated with an early virological response, they found that these once again included infection with genotypes 2 and 3 (p < 0.001), a rapid virological response (p < 0.001), but also a lack of antiretroviral therapy (p = 0.043).
The investigators were surprised by this final finding. But they said that patients with high CD4 cell counts, and therefore no need to take anti-HIV treatment, were therefore able to avoid the possible liver-toxic interactions between antiretroviral and anti-hepatitis C drugs, increasing the chances of their livers clearing hepatitis C infection.
Reference
Janke M. et al. Which factors predict early and sustained virological response under combination hepatitis C therapy in HIV/HCV co-infected patients? Fourth International Workshop on HIV and Hepatitis Coinfection, Madrid, abstract 14, 2008.