Rates and predictors of response to anti‐viral treatment for hepatitis C virus in<scp>HIV</scp>/<scp>HCV</scp>co‐infection in a nationwide study of 619 patients

Ioannou, George N.; Scott, John D.; Yin, Yuehui; Green, P. K.; Beste, Lauren A.

doi:10.1111/apt.12524

Cited by 14 publications

(8 citation statements)

References 38 publications

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“…The overall SVR rates of 35.1% in GT 1/4 and 70.3% in GT 2/3 infections were high compared to other HIV/HCV-coinfected cohorts and similar to cure rates achieved in randomized controlled trials [ 24 – 26 ]. In a large cohort of US veterans, SVR was 16.7% in GT 1 and 44% in GT 2/3 infections during the same time period [ 27 ]. In our cohort, main predictors for SVR in both HCV genotype groups were IL28B genotype CC and low HCV RNA levels at baseline, which is in accordance with the results from other studies [ 19 , 27 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

Ribavirin Concentrations Do Not Predict Sustained Virological Response in HIV/HCV-Coinfected Patients Treated with Ribavirin and Pegylated Interferon in the Swiss HIV Cohort Study

et al. 2015

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BackgroundRibavirin (RBV) is an essential component of most current hepatitis C (HCV) treatment regimens and still standard of care in the combination with pegylated interferon (pegIFN) to treat chronic HCV in resource limited settings. Study results in HIV/HCV-coinfected patients are contradicting as to whether RBV concentration correlates with sustained virological response (SVR).MethodsWe included 262 HCV treatment naïve HIV/HCV-coinfected Swiss HIV Cohort Study (SHCS) participants treated with RBV and pegIFN between 01.01.2001-01.01.2010, 134 with HCV genotype (GT) 1/4, and 128 with GT 2/3 infections. RBV levels were measured retrospectively in stored plasma samples obtained between HCV treatment week 4 and end of therapy. Uni- and multivariable logistic regression analyses were used to evaluate the association between RBV concentration and SVR in GT 1/4 and GT 2/3 infections. The analyses were repeated stratified by treatment phase (week 4-12, 13-24, >24) and IL28B genotype (CC versus CT/TT).ResultsSVR rates were 35.1% in GT 1/4 and 70.3% in GT 2/3 infections. Overall, median RBV concentration was 2.0 mg/L in GT 1/4, and 1.9 mg/L in GT 2/3, and did not change significantly across treatment phases. Patients with SVR had similar RBV concentrations compared to patients without SVR in both HCV genotype groups. SVR was not associated with RBV levels ≥2.0 mg/L (GT 1/4, OR 1.19 [0.5-2.86]; GT 2/3, 1.94 [0.78-4.80]) and ≥2.5 mg/L (GT 1/4, 1.56 [0.64-3.84]; GT 2/3 2.72 [0.85-8.73]), regardless of treatment phase, and IL28B genotype.ConclusionIn HIV/HCV-coinfected patients treated with pegIFN/RBV, therapeutic drug monitoring of RBV concentrations does not enhance the chance of HCV cure, regardless of HCV genotype, treatment phase and IL28B genotype.

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Section: Discussionmentioning

confidence: 99%

Ribavirin Concentrations Do Not Predict Sustained Virological Response in HIV/HCV-Coinfected Patients Treated with Ribavirin and Pegylated Interferon in the Swiss HIV Cohort Study

et al. 2015

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“…The rate of fibrosis is also accelerated in chronically coinfected patients, leading to an earlier onset of end-stage liver disease and significantly increased HCV-related mortality [11,12,13]. The expected sustained virological response (SVR) rates of chronic HCV (c-HCV) to peginterferon and ribavirin (P/R) therapy also diminish considerably, from 50% in treatment-naive monoinfected individuals to 37% in those coinfected and without prior treatment [14,15], which may overestimate real-world outcomes [16]. While preliminary results suggest that the new direct-acting antivirals (DAA) are highly effective for c-HCV [17,18,19], their cost and accessibility limit their availability compared to the traditional P/R regimen in areas where HIV is endemic [20].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Acute Hepatitis C Infection with Pegylated Interferon and Ribavirin in Patients Coinfected with Human Immunodeficiency Virus: A Systematic Review and Meta-Analysis

Zhang

Nguyen²,

Yee³

et al. 2015

Intervirology

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Background/Aims: Of the 35 million human immunodeficiency virus (HIV)-positive patients worldwide, 10-40% are coinfected with chronic hepatitis C virus (HCV). Compared to HCV-monoinfected patients, those coinfected experience decreased spontaneous HCV clearance, accelerated liver fibrosis, and a decreased response to anti-HCV therapy. We conducted a meta-analysis to estimate the efficacy of treating acute HCV in HIV-positive patients with peginterferon and ribavirin combination therapy. Methods: Two authors independently searched MEDLINE and EMBASE (2014) for English articles, and reviewed bibliographies and abstracts from major liver and HIV conferences (2011-2013). Original studies featuring at least 10 treatment-naive, HIV-positive adults infected with acute HCV and treated with peginterferon and ribavirin were included. Analyses were calculated using a random-effects model. Heterogeneity was assessed using the Cochrane Q test (p < 0.05) and the I² statistic (>50%). Results: From 12 studies (450 patients), the pooled sustained virological response (SVR) was 71.4% (95% CI 64.7-77.4; Q statistic = 22.20, p = 0.023, I² = 50.44). The rapid virological response (RVR; 7 studies, 196 patients) was 47.4% (95% CI 40.6-54.7), and the early virological response (EVR; 9 studies, 283 patients) was 82.8% (95% CI 67.0-92.0). The probability of an SVR was 93.1% (95% CI 84.9-97.0) in those who obtained an RVR (6 studies, 82 patients) and 85.9% (95% CI 78.7-91.0) if an EVR (7 studies, 168 patients) was reached. Conclusion: Peginterferon with ribavirin is an effective option for treating acute HCV in HIV-positive patients, especially if they achieve an RVR or an EVR.

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“…However, these data are limited by inclusion of only a small number of black patients (n = 308) and furthermore do not capture real‐world outcomes. Disparities in difficult‐to‐treat populations are often accentuated in real‐world practice compared to clinical trials …”

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confidence: 99%

“…Disparities in difficult-to-treat populations are often accentuated in real-world practice compared to clinical trials. (21,22) In this study we aimed to compare the real-world effectiveness of SOF, SMV1SOF, LDV/SOF, and PrOD-based regimens among different racial and ethnic groups treated in the Veterans Affairs (VA) health care system nationally. The VA provides an optimal setting to study race/ethnicity-related disparities in DAA effectiveness due to the high prevalence of HCV among veterans, the large population of racial and ethnic minorities, the nationwide distribution of the VA system, and the lack of confounding factors related to health insurance coverage.…”

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confidence: 99%

The association between race/ethnicity and the effectiveness of direct antiviral agents for hepatitis C virus infection

Green

Berry

et al. 2016

Hepatology

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Direct-acting antivirals produce high SVR rates in white, black, Hispanic, and Asian/Pacific Islander/American Indian/Alaska Native patients; but after adjusting for baseline characteristics, black race and Hispanic ethnicity remain independent predictors of treatment failure. Short 8-week ledipasvir/sofosbuvir monotherapy regimens should perhaps be avoided in black patients with genotype 1 hepatitis C virus. (Hepatology 2017;65:426-438).

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Rates and predictors of response to anti‐viral treatment for hepatitis C virus inHIV/HCVco‐infection in a nationwide study of 619 patients

Abstract: SUMMARY BackgroundThe effectiveness of anti-viral treatment for hepatitis C virus (HCV) in HIV/HCV co-infected patients in 'real world', clinical practice is unclear.

Cited by 14 publications

References 38 publications

Ribavirin Concentrations Do Not Predict Sustained Virological Response in HIV/HCV-Coinfected Patients Treated with Ribavirin and Pegylated Interferon in the Swiss HIV Cohort Study

Ribavirin Concentrations Do Not Predict Sustained Virological Response in HIV/HCV-Coinfected Patients Treated with Ribavirin and Pegylated Interferon in the Swiss HIV Cohort Study

Treatment of Acute Hepatitis C Infection with Pegylated Interferon and Ribavirin in Patients Coinfected with Human Immunodeficiency Virus: A Systematic Review and Meta-Analysis

The association between race/ethnicity and the effectiveness of direct antiviral agents for hepatitis C virus infection

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