Treatment of Chronic Hepatitis C in HIV-Infected Patients with Interferon α-2b Plus Ribavirin

Abstract

One hundred six HIV-infected patients with chronic hepatitis C virus (HCV) infection were randomized to receive ribavirin (RBV) 400 mg bid plus interferon a-2b (IFN-a) at two different doses, 3 mU tiw (control arm) or 5 mU daily for the first 6 weeks, followed by 3 mU tiw until completing 6 months of therapy (induction arm). All patients had CD4 counts above 350 cells/ml and 89% were taking antiretroviral therapy. Adverse effects leading to treatment discontinuation occurred in 12.3% of patients, a rate quite similar to that seen in HCV-monoinfected patients. Negative serum HCV-RNA values (,60 IU/ml) were recorded in 24.7% and 35.5% of patients at 3 and 6 months of therapy. However, in the intent-to-treat analysis, sustained response was reached by only 16% of patients (22.4% in the on-treatment analysis). No differences between treatment arms were noticed. Patients with HCV genotypes 2 or 3 had a 7-fold higher response rate than those with HCV genotypes 1 or 4. Therefore, early, end-of-treatment, and sustained response rates are lower in HIV/HCV-coinfected patients treated with RBV/IFN-a combination therapy. Since HCV-related liver disease is currently one of the leading causes of morbidity and mortality among HIV-infected patients, new treatment options are urgently needed for coinfected individuals.

Hepatitis C: a review for primary care physicians

“…86,[129][130][131] In the presence of HIV, the response to HCV antiviral therapy is not as favourable (sustained virologic response of 14%-38% for genotype 1 and 43%-73% for genotype 2 or 3) and adverse events are more common (Table 3). [118][119][120][121] HAART has a favourable effect on the course of hepatitis C, but hepatotoxicity from HAART is a challenge. 132,133 In HIV-infected people, HCV seropositivity is an independent predictor of HIV progression and mortality.…”

Treatment of chronic hepatitis C virus in allogeneic bone marrow transplant recipients

“…Among 106 patients coinfected with HIV/HCV, only 16% had a sustained virological response mainly because of discontinuation due to adverse events. 11 In liver transplantation, PEG IFN and RBV treatment achieved virological response in nine out of 20 patients (45%). Treatment was withdrawn in four patients (20%) and the dose of PEG IFN and of RBV was reduced for six and 13 patients, respectively.…”

Allogeneic hematopoietic cell transplant in HCV-infected patients

“…HCV treatment is thus often associated with a poor response. Among 106 patients co-infected with HIV/HCV, only 16% had a sustained virological response mainly because of discontinuation due to adverse events [89]. In liver transplantation, PEG IFN and RBV treatments achieved virological response in 9 out of 20 patients (45%).…”