Baseline Serum Hepatitis C Virus (HCV) RNA Level and Response at Week 4 Are the Best Predictors of Relapse After Treatment With Pegylated Interferon Plus Ribavirin in HIV/HCV-Coinfected Patients

Núñez, Marina; Marino, Angel; Miralles, Celia; Berdún, Miguel Angel; Sola, Julio; Hernandez-Burruezo, Juan Jose; Galindo, Marı́a José; Barreiro, Pablo; Martín‐Carbonero, Luz; Soriano, Vincent

doi:10.1097/qai.0b013e318061b5d9

Cited by 39 publications

(19 citation statements)

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“…The main reason for this result was the percentage of relapses among patients with an ETR. A high proportion of relapses has been observed previously in patients infected by HCV genotype 3 [38], [43], [44]. This has been attributed either to insufficient doses of RBV or to a short duration of treatment (24 weeks) when a RVR had not been achieved [38].…”

Section: Discussionmentioning

confidence: 94%

“…Effectively, a higher relapse rate after completing a course of therapy could contribute to a lower SVR in this population [38]. Relapses were detected in 24 patients (13% of the total population, 21% of those with ETR), within the range seen in other series of coinfected patients treated with Peg-IFN plus RBV (range: 15%–37% of those with ETR) [38], [39]. Relapses were especially present in those individuals without a RVR (only one patient with RVR experienced relapse after suppression of anti-HCV therapy).…”

Section: Discussionmentioning

confidence: 99%

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Liver Fibrosis, Host Genetic and Hepatitis C Virus Related Parameters as Predictive Factors of Response to Therapy against Hepatitis C Virus in HIV/HCV Coinfected Patients

et al. 2014

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ObjectiveTo establish the role of liver fibrosis as a predictive tool of response to pegylated interferon alpha (Peg-IFN) and ribavirin (RBV) treatment in human immunodeficiency (HIV)/hepatitis C virus (HCV) coinfected patients, in addition to recognized predictive factors (HCV load, HCV genotype, IL-28B polymorphism).Patients and MethodsA sample of 267 HIV/HCV coinfected patients was treated with Peg-IFN and RBV. Predictive factors of rapid (RVR) and sustained (SVR) virological response were analyzed. Independent variables were age, sex, IL28B, −238 TNF-α and −592 IL-10 polymorphisms, HCV genotype, HCV-RNA levels, significant fibrosis or cirrhosis and CD4+ T cell count.ResultsPatients infected by HCV genotype 1 (n = 187) showed RVR and SVR in 12% and 39% of cases, respectively. The parameters associated with RVR were IL28B genotype CC and plasma HCV-RNA levels <600000 IU/ml. Advanced liver fibrosis was negatively associated with SVR in patients without RVR. A SVR was obtained in 42% of subjects with HCV genotype 4, and the independent factors associated with SVR were IL28B genotype CC and an HCV-RNA <600000 IU/ml. A SVR was obtained in 66% of patients with HCV genotypes 2/3; in this case, the independent parameter associated with SVR was the absence of significant liver fibrosis. TNF-α and IL-10 polymorphisms were not associated with SVR, although a significantly higher percentage of −238 TNF-α genotype GG was detected in patients with significant liver fibrosis.ConclusionsIn HIV/HCV coinfected patients with HCV genotypes 1 or 4, RVR, mainly influenced by genotype IL28B and HCV-RNA levels, reliably predicted SVR after 4 weeks of therapy with Peg-IFN plus RBV. In patients infected by HCV genotype 3, an elevated relapse rate compromised the influence of RVR on SVR. Relapses were related to the presence of advanced liver fibrosis. Liver cirrhosis was associated with a −238 TNF-α polymorphism in these patients.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Liver Fibrosis, Host Genetic and Hepatitis C Virus Related Parameters as Predictive Factors of Response to Therapy against Hepatitis C Virus in HIV/HCV Coinfected Patients

et al. 2014

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“…Predictors of treatment response with peginterferon/ribavirin therapy are factors largely related to HCV: rapid virologic response (RVR), HCV genotype, HCV viral load, IL28B gene variation, and liver disease stage, however, the SVR rates in HIV/HCV co-infected patients are 15–20 % lower than those in patients with HCV mono-infection. Likewise, rates of hepatic decompensation during peginterferon/ribavirin treatment are considerably higher in co-infected patients than in HCV mono-infected patients, especially among cirrhotics [2, 128–133]. For interferon-based treatment regimens, please refer to the previous report for further verification [1].…”

Section: Svr For Renal Failure and Co-infection With Hbv/hivmentioning

confidence: 99%

APASL consensus statements and recommendation on treatment of hepatitis C

et al. 2016

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The Asian-Pacific Association for the Study of the Liver (APASL) convened an international working party on the “APASL consensus statements and recommendation on management of hepatitis C” in March, 2015, in order to revise “APASL consensus statements and management algorithms for hepatitis C virus infection (Hepatol Int 6:409–435, 2012)”. The working party consisted of expert hepatologists from the Asian-Pacific region gathered at Istanbul Congress Center, Istanbul, Turkey on 13 March 2015. New data were presented, discussed and debated to draft a revision. Participants of the consensus meeting assessed the quality of cited studies. Finalized recommendations on treatment of hepatitis C are presented in this review.Electronic supplementary materialThe online version of this article (doi:10.1007/s12072-016-9717-6) contains supplementary material, which is available to authorized users.

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“…Two large registration trials have shown lower sustained virologic response rates (SVR) for dual therapy in HIV/HCV co-infected patients (~33%) compared to mono-infected patients (47-54%) [8-12]. Higher baseline HCV RNA levels and lower initial ribavirin doses are quoted as possible explanation for the lower SVR seen in co-infected patients [13]. Recent data suggest that higher ribavirin doses are safe and well-tolerated in co-infected patients [14].…”

Section: Introductionmentioning

confidence: 99%

German cohort of HCV mono-infected and HCV/HIV co-infected patients reveals relative under-treatment of co-infected patients

et al. 2014

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BackgroundCurrent German and European HIV guidelines recommend early evaluation of HCV treatment in all HIV/HCV co-infected patients. However, there are still considerable barriers to initiate HCV therapy in everyday clinical practice. This study evaluates baseline characteristics, “intention-to-treat” pattern and outcome of therapy of HCV/HIV co-infected patients in direct comparison to HCV mono-infected patients in a “real-life” setting.MethodsA large, single-center cohort of 172 unselected HCV patients seen at the Infectious Diseases Unit at the University Medical Center Hamburg-Eppendorf from 2000–2011, 88 of whom HCV/HIV co-infected, was retrospectively analyzed by chart review with special focus on demographic, clinical and virologic aspects as well as treatment outcome.ResultsAntiviral HCV combination therapy with PEG-interferon plus weight-adapted ribavirin was initiated in 88/172 (52%) patients of the entire cohort and in n = 36 (40%) of all HCV/HIV co-infected patients (group A) compared to n = 52 (61%) of the HCV mono-infected group (group B) (p = 0.006). There were no significant differences of the demographics or severity of the liver disease between the two groups with the exception of slightly higher baseline viral loads in group A. A sustained virologic response (SVR) was observed in 50% (n = 18) of all treated HIV/HCV co-infected patients versus 52% (n = 27) of all treated HCV mono-infected patients (p = 0.859). Genotype 1 was the most frequent genotype in both groups (group A: n = 37, group B: n = 49) and the SVR rates for these patients were only slightly lower in the group of co-infected patients (group A: n = 33%, group B: 40% p = 0.626). During the course of treatment HCV/HIV co-infected patients received less ribavirin than mono-infected patients.ConclusionOverall, treatment was only initiated in half of the patients of the entire cohort and in an even smaller proportion of HCV/HIV co-infected patients despite comparable outcome (SVR) and similar baseline characteristics. In the light of newer treatment options, greater efforts to remove the barriers to treatment that still exist for a great proportion of patients especially with HIV/HCV co-infection have to be undertaken.

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Baseline Serum Hepatitis C Virus (HCV) RNA Level and Response at Week 4 Are the Best Predictors of Relapse After Treatment With Pegylated Interferon Plus Ribavirin in HIV/HCV-Coinfected Patients

Abstract: High baseline serum HCV RNA level and lack of undetectable viremia at week 4 are the most significant predictors of relapse in HCV/HIV-coinfected patients treated with peg-IFN plus weight-based RBV.

Cited by 39 publications

References 19 publications

Liver Fibrosis, Host Genetic and Hepatitis C Virus Related Parameters as Predictive Factors of Response to Therapy against Hepatitis C Virus in HIV/HCV Coinfected Patients

Liver Fibrosis, Host Genetic and Hepatitis C Virus Related Parameters as Predictive Factors of Response to Therapy against Hepatitis C Virus in HIV/HCV Coinfected Patients

APASL consensus statements and recommendation on treatment of hepatitis C

German cohort of HCV mono-infected and HCV/HIV co-infected patients reveals relative under-treatment of co-infected patients

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