Pegylated interferon α-2b plus ribavirin for the treatment of chronic hepatitis C in HIV-coinfected patients

Voigt, Esther; Schulz, Christian; Klausen, Gerd; Goelz, J.; Mauss, Stefan; Schmutz, G; Jessen, Heiko; Weitner, Lutwin; Mutz, Antonius; Schranz, Dietmar; Rockstroh, Juergen

doi:10.1016/j.jinf.2005.09.007

Cited by 38 publications

(27 citation statements)

References 24 publications

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“…In HIV/HCV co-infected patients, results obtained with PEG-IFN + ribavirin (RBV) [39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] were superior to those with PEG-IFN alone, standard IFN alone [48] , or standard IFN + RBV (Table 2). A meta-analyses of 6 randomized controlled studies showed superior sustained virologic response (SVR) with PEG-IFN + RBV compared with IFN + RBV and PEG-IFN monotherapy.…”

Section: Therapeutic Regimen For Treating Hcvmentioning

confidence: 99%

“…Pérez-Olmeda et al [39] Cargnel et al [40] ( Laguno et al [42] ( Myers et al [43] ( Chung et al [44] ( Moreno et al [45] ( Torriani et al [46] ( [49] Moreno et al [50] ( Voigt et al [52] ( Fuster et al [53] ( Righi et al [54] ( Responses are on intent to treat analysis. ETR: End of treatment response (HCVRNA < 50 copies/mL); SVR: Sustained virologic response (HCVRNA < 50 copies/mL 6 mo after discontinuing treatment); PEG-IFN: Pegylated interferon; RBV-ribavirin; GT: Genotype; tiw: Three times a week; ACTG: AIDS clinical trial group; APRICOT: AIDS pegasys ribavirin international coinfection trial.…”

Section: Etr Svr Etr Svr Etr Svrmentioning

confidence: 99%

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Management of hepatitis C virus infection in HIV/HCV co-infected patients: Clinical review

Singal¹,

Anand²

2009

WJG

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N e a r l y o n e fo u r t h o f i n d i v i d u a l s w i t h h u m a n immunodeficiency virus (HIV) infection have hepatitis C virus (HCV) infection in the US and Western Europe. With the availability of highly active antiretroviral therapy and the consequent reduction in opportunistic infections, resulting in the prolongation of the life span of HIV-infected patients, HCV co-infection has emerged as a significant factor influencing the survival of HIV patients. Patients with HIV/HCV co-infection have a faster rate of fibrosis progression resulting in more frequent occurrences of cirrhosis, end-stage liver disease, and hepatocellular carcinoma. However, the mechanism of interaction between the two viruses is not completely understood. The treatment for HCV in co-infected patients is similar to that of HCV monoinfection; i.e., a combination of pegylated interferon and ribavirin. The presence of any barriers to anti-HCV therapy should be identified and eliminated in order to recruit all eligible patients. The response to treatment in co-infected patients is inferior compared to the response in patients with HCV mono-infection. The sustained virologic response rate is only 38% for genotype-1 and 75% for genotype-2 and -3 infections. Liver transplantation is no longer considered a contraindication for end-stage liver disease in coinfected patients. However, the 5 year survival rate is lower in co-infected patients compared to patients with HCV mono-infection (33% vs 72%, P = 0.07). A better understanding of liver disease in co-infected patients is needed to derive new strategies for improving outcome and survival.

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Section: Therapeutic Regimen For Treating Hcvmentioning

confidence: 99%

Section: Etr Svr Etr Svr Etr Svrmentioning

confidence: 99%

Management of hepatitis C virus infection in HIV/HCV co-infected patients: Clinical review

Singal¹,

Anand²

2009

WJG

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“…Several mechanisms of action have been proposed to explain its anti-HCV effect, including direct inhibition of the viral RNA polymerase, IMP dehydrogenase inhibition, hypermutagenesis, and immunomodulation (7). Pharmacokinetic-pharmacodynamic studies conducted in HCV-monoinfected and HIV-HCV-coinfected patients have found an association between RBV concentrations and achievement of early and sustained virological responses (reviewed in references 5 and 15 and a recent paper [3]), indirectly supporting a role for therapeutic drug monitoring of RBV concentrations to tailor RBV dosage early in treatment and in this way to try to enhance the chances of SVR.In addition to a lower initial response to hepatitis C therapy, a higher rate of HCV relapse (range, 15% to 37%) (4,6,16,20,21,23) could contribute to the lower rate of SVR seen in HIV-HCV-coinfected patients than in HCV-monoinfected patients. Several factors such as high baseline HCV RNA and lack of rapid virological response (RVR) have been associated with HCV relapse (16).…”

mentioning

confidence: 93%

“…In addition to a lower initial response to hepatitis C therapy, a higher rate of HCV relapse (range, 15% to 37%) (4,6,16,20,21,23) could contribute to the lower rate of SVR seen in HIV-HCV-coinfected patients than in HCV-monoinfected patients. Several factors such as high baseline HCV RNA and lack of rapid virological response (RVR) have been associated with HCV relapse (16).…”

mentioning

confidence: 99%

Plasma Ribavirin Trough Concentrations at Week 4 Predict Hepatitis C Virus (HCV) Relapse in HIV-HCV-Coinfected Patients Treated for Chronic Hepatitis C

Morello

Soriano²,

Barreiro³

et al. 2010

Antimicrob Agents Chemother

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The standard treatment for chronic hepatitis C virus (HCV) infection is the combination of pegylated alpha interferon (pegIFN) and ribavirin (RBV), which allows cure of HCV in around 50 to 60% of HCV-monoinfected patients (8, 12) and 30 to 40% of HIV-HCV-coinfected individuals (4, 21). Although new drugs for treating HCV infection, such as HCV protease inhibitors, are currently being developed, preliminary evidence (9, 10) suggests that the use of RBV seems unavoidable for maximizing the chances of sustained virological response (SVR).RBV is a synthetic guanosine analogue. Several mechanisms of action have been proposed to explain its anti-HCV effect, including direct inhibition of the viral RNA polymerase, IMP dehydrogenase inhibition, hypermutagenesis, and immunomodulation (7). Pharmacokinetic-pharmacodynamic studies conducted in HCV-monoinfected and HIV-HCV-coinfected patients have found an association between RBV concentrations and achievement of early and sustained virological responses (reviewed in references 5 and 15 and a recent paper [3]), indirectly supporting a role for therapeutic drug monitoring of RBV concentrations to tailor RBV dosage early in treatment and in this way to try to enhance the chances of SVR.In addition to a lower initial response to hepatitis C therapy, a higher rate of HCV relapse (range, 15% to 37%) (4,6,16,20,21,23) could contribute to the lower rate of SVR seen in HIV-HCV-coinfected patients than in HCV-monoinfected patients. Several factors such as high baseline HCV RNA and lack of rapid virological response (RVR) have been associated with HCV relapse (16). However, the impact of RBV concentrations on the risk of HCV relapse is unknown. If a significant association exists, adjustment of RBV dosages based on early RBV concentrations could be very useful to minimize the risk of HCV relapse.A retrospective study was performed in HIV-HCV-coinfected patients who achieved end-of-treatment (EOT) response with pegIFN-␣ 2a or 2b (180 g/week or 1.5 g/kg of body weight/week) plus weight-based RBV (1,000 or 1,200 mg/day for patients weighting Ͻ75 or Ͼ75 kg, respectively) since 2004 at our clinic. The duration of treatment was based on HCV genotype and the achievement of undetectable HCV RNA at week 4 (RVR), ranging from 6 to 18 months (11,17).Demographics and other clinical characteristics were recorded in a case report form specially designed for this study. Serum HCV RNA was measured at baseline, every 4 to 12 weeks of therapy, and 24 weeks after completion of treatment by TaqMan (Roche), with a limit of detection of 10 IU/ml. HCV genotyping was examined using a hybridization assay (InnoLipa-HCV; Bayer). RBV plasma trough concentrations (RBV C trough ) were measured before the intake of the first daily dose of RBV at week 4 of therapy by high-performance liquid chromatography with ultraviolet detector (HPLC-UV) (14).EOT response was defined as undetectable HCV RNA at the end of therapy. HCV relapse was defined as detectable HCV RNA within the next 24 weeks after achieving EOT response.S...

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“…The majority of the pivotal studies of antiviral therapy in HIV/HCV-coinfected patients were conducted with suboptimal RBV dosing, which was prompted by concerns of interactions between certain antiretrovirals and RBV. SVR rates of 14% to 29% were found in HIV/HCV genotype 1 patients treated with standard doses of PEG-IFN-and RBV 800 mg daily [17][18][19][20]. The baseline factors associated with higher SVR rates are similar to those in HCV-monoinfected patients.…”

Section: Baseline Factors Predictive Of Svr In Genotype 1 Patients: Wmentioning

confidence: 81%

Optimizing therapy in treatment-naïve genotype 1 patients

Agudelo¹,

Terrault

2008

Curr hepatitis rep

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With the current standard dose and duration of pegylated interferon (PEG-IFN) and ribavirin (RBV), a sustained virologic response (SVR) is obtained in about 40% to 45% of patients with hepatitis C virus genotype 1. Few baseline characteristics can be modified to enhance response rates, so the focus of recent studies has been on whether increasing the dose and duration of treatment can improve SVR rates. Emerging data support consideration of higher-dose RBV and possibly higher doses of PEG-IFN. Additionally, for those not achieving a complete early virologic response, extending treatment from 48 to 72 weeks reduces relapse rates and improves sustained responses. Adherence remains an important "on-treatment factor" influencing responses, but studies are inconsistent in terms of what the "critical" cutoff for dose reductions is. At present, the best strategy to maximize SVR rates for genotype 1 and other "difficult-to-treat" populations includes determining whether any baseline factors can be modified before treatment, maximizing adherence, considering use of higher drug doses, and adjusting treatment duration based on early virologic responses.

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Pegylated interferon α-2b plus ribavirin for the treatment of chronic hepatitis C in HIV-coinfected patients

Cited by 38 publications

References 24 publications

Management of hepatitis C virus infection in HIV/HCV co-infected patients: Clinical review

Management of hepatitis C virus infection in HIV/HCV co-infected patients: Clinical review

Plasma Ribavirin Trough Concentrations at Week 4 Predict Hepatitis C Virus (HCV) Relapse in HIV-HCV-Coinfected Patients Treated for Chronic Hepatitis C

Optimizing therapy in treatment-naïve genotype 1 patients

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