Low Rates of Sustained Virologic Response with Peginterferon Plus Ribavirin for Chronic Hepatitis C Virus Infection in HIV Infected Patients in Rio de Janeiro, Brazil

Barcaui, Halime Silva; Tavares, G.C; May, Silvia Beatriz; Brandão‐Mello, Carlos Eduardo; Pires, Marcia Maria Amêndola; Barroso, Paulo Feijó

doi:10.1371/journal.pone.0067734

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…[94] A study conducted in a public health setting in Brazil observed a similarly low SVR rate (27%) as those observed in clinical trials. [95] The use of weight-based ribavirin (compared to fixed low-doses of ribavirin) and extended duration of therapy has resulted in increased SVR rates, as demonstrated in the PRESCO trial in co-infected patients (SVR 50%) [96] In addition, avoidance of antiretroviral drugs such as zidovudine, didanosine, and stavudine in combination with ribavirin is recommended, given the risks of severe anaemia, pancreatitis, and lactic acidosis. [97-101]…”

Section: Management Of Hiv and Hcv Co-infectionmentioning

confidence: 99%

HCV and HIV co-infection: mechanisms and management

Chen

Feeney

Chung

2014

Nat Rev Gastroenterol Hepatol

168

135

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HCV and HIV co-infection is associated with accelerated hepatic fibrosis progression and higher rates of liver decompensation and death compared to HCV monoinfection, and liver disease is a leading cause of non-AIDS related mortality among HIV-infected patients. New insights have revealed multiple mechanisms by which HCV and HIV lead to accelerated disease progression, specifically that HIV infection increases HCV replication, augments HCV-induced hepatic inflammation, increases hepatocyte apoptosis, increases microbial translocation from the gut, and leads to an impairment of HCV-specific immune responses. Treatment of HIV with antiretroviral therapy and treatment of HCV have independently been shown to delay the progression of fibrosis and reduce complications from end-stage liver disease among co-infected patients. However, rates of sustained virologic response with PEG-IFN and ribavirin have been significantly inferior among co-infected patients compared to HCV monoinfected patients, and treatment uptake has remained low given the limited efficacy and tolerability of current HCV regimens. With multiple direct acting antivirals in development to treat HCV, a unique opportunity exists to redefine the treatment paradigm for co-infected patients, which incorporates data on fibrosis stage as well as potential drug interactions with antiretroviral therapy.

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Section: Management Of Hiv and Hcv Co-infectionmentioning

confidence: 99%

HCV and HIV co-infection: mechanisms and management

Chen

Feeney

Chung

2014

Nat Rev Gastroenterol Hepatol

168

135

View full text Add to dashboard Cite

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“…Hepatitis C virus (HCV) infection is highly prevalent (20-40%) in subjects infected with the human immunodeficiency virus (HIV) because of common transmission pathways [ 1 ]. HIV/HCV coinfected subjects have higher HCV viral load, faster progression to cirrhosis, higher incidence of liver decompensation and liver related deaths when compared to HCV monoinfected patients [ 2 , 3 ]. The primary goal of HCV therapy is to cure the infection, which results in the elimination of the virus after cessation of treatment in a variable proportion of patients according to genotype [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Sustained virological response to peginterferon therapy in patients infected with HCV (genotypes 2 and 3), with or without HIV

et al. 2014

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BackgroundHIV infection leads to a faster progression of liver disease in subjects infected with HCV, as compared with HCV mono-infected patients. Previous reports suggest that sustained virological response (SVR) rates are lower in HIV/HCV coinfection than in HCV monoinfection. We aimed to compare SVR rates of these two populations.MethodsWe retrospectively analyzed clinical, biochemical and virological data of HCV and HIV/HCV infected patients with HCV genotypes 2 and 3 who started anti-HCV treatment between March 2004 and November 2012, at a single large center. Intention-to-treat (ITT) and per-protocol (PP) analysis were performed. Univariate and multivariate logistic regression analyses were performed to assess predictors of SVR.Results461 patients were analyzed: 307 (66.6%) males, 76 (16.5%) infected with HIV. Several differences at baseline between HCV monoinfected and HIV/HCV coinfected patients were observed. HCV monoinfected group was characterized by higher prevalence of genotype 2 (53% vs 5.3%), higher baseline HCV viral load (50% vs 35%), shorter mean duration of treatment (19 vs 41 weeks), more frequent use of peginterferon alfa-2a (84.5% vs 69.7%), lower prevalence of cirrhosis (6% vs 31.6%). Globally, SVR was achieved by 353 (76.6%) patients and 321 (83.8%) in the PP analysis. No statistically relevant differences were found in SVR rates between the two groups, either in ITT [78.2% (n = 301/385) vs 68.4% (n = 52/76), p =0.066, respectively] than in PP analysis [83.6% (n = 276/330) vs 84.9% (n = 45/53), p = 0.8].ITT analysisAt univariate and multivariate analysis, baseline HCV-RNA >500.000 IU/ml [OR 0.4 (0.24-0.66), p = 0.0004], use of peginterferon alfa-2b [OR 0.5 (0.27-0.93) p = 0.033], platelets count <130.000/mm3 [OR 0.45 (0.2-0.99), p = 0.045], interruption of peginterferon therapy [OR 0.2 (0.1-0.4), p<0.0001], interruption of ribavirin treatment [OR 0.34 (0.17-0.69), p = 0.0026] were related with lower rate of SVR.PP analysisOnly HCV-RNA >500.000 IU/ml and interruption of ribavirin were related to lower probability to achieve SVR at both univariate and multivariate analysis [OR 0.41 (0.23-0.75), p = 0.004; OR 0.24 (0.1-0.5), p = 0.0004, respectively].ConclusionsHigher baseline viral loads and interruption of peginterferon and/or ribavirin were associated with a poor outcome of anti-HCV treatment while HIV infection was not related to major or minor probability to achieve SVR.

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“…On the other hand, we found no association between CD4 and HIV-RNA count and the SVR rate. This is a controversial finding in the literature, since some authors found no relationship between CD4 cell count [47,48] or HIV-RNA viral load and SVR. However, Pineda et al [27] observed that CD4 cell count above 300 cell/mm 3 was an independent factor of better SVR.…”

Section: Discussionmentioning

confidence: 93%

Antiretroviral therapy does not affect response to chronic hepatitis C therapy in HIV-coinfected patients

Leon

Tovo

Kliemann

et al. 2016

J Infect Dev Ctries

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Introduction: Many patients coinfected with the human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are using highly active antiretroviral therapy (HAART) and HCV therapy with peginterferon (PEG-IFN) and ribavirina (RBV) because the use of direct-acting antivirals is not a reality in some countries. To know the impact of such medications in the sustained virological response (SVR) during HCV treatment is of great importance. Methodology: This was a retrospective cohort study of 215 coinfected HIV/HCV patients. The patients were treated with PEG-IFN and RBV between 2007 and 2013 and analyzed by intention to treat. Treatment-experienced patients to HCV and carriers of hepatitis B were excluded. Demographic data (gender, age), mode of infection, HCV genotype, HCV viral load, hepatic fibrosis, HIV status, and type of PEG were evaluated. One hundred eighty-eight (87.4%) patients were using HAART. Results: SVR was achieved in 55 (29.3%) patients using HAART and in 9 (33.3%) patients not using HAART (p = 0.86). There was no difference in SVR between different HAART medications and regimens using two reverse transcriptase inhibitor nucleosides (NRTIs) or the use of protease inhibitors and non-NRTIs (27.1% versus 31.5%; p = 0.61). The predictive factors for obtaining SVR were low HCV viral load, non-1 genotype, and the use of peginterferon-α2a. Conclusions: The use of HAART does not influence the SVR of HCV under PEG-IFN and RBV therapy in HIV/HCV coinfected patients.

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Low Rates of Sustained Virologic Response with Peginterferon Plus Ribavirin for Chronic Hepatitis C Virus Infection in HIV Infected Patients in Rio de Janeiro, Brazil

Cited by 7 publications

References 24 publications

HCV and HIV co-infection: mechanisms and management

HCV and HIV co-infection: mechanisms and management

Sustained virological response to peginterferon therapy in patients infected with HCV (genotypes 2 and 3), with or without HIV

Antiretroviral therapy does not affect response to chronic hepatitis C therapy in HIV-coinfected patients

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