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. 2012 Spring;23(1):31-5.
doi: 10.1155/2012/384630.

Optimizing hepatitis C therapy in HIV/hepatitis C virus (HCV) coinfected patients: Analysis of HCV viral kinetics on treatment

Paul Damien James  1 , David Kh Wong
Affiliations

Optimizing hepatitis C therapy in HIV/hepatitis C virus (HCV) coinfected patients: Analysis of HCV viral kinetics on treatment

Paul Damien James et al. Can J Infect Dis Med Microbiol. 2012 Spring.

Abstract
in English, French

Introduction: Hepatitis C virus (HCV) infection is potentially curable, but the sustained virological response (SVR) has been shown to be lower in patients coinfected HIV. A single-centre experience treating individuals with HCV and HIV coinfection is reported.

Methods: Twenty-one patients who received standard doses of pegylated interferon with weight-based dosing of ribavirin (mean 14.3 mg/kg) were retrospectively reviewed. Qualitative HCV polymerase chain reaction (PCR) was performed prospectively every four weeks if the patient remained HCV PCR positive. All patients with HCV genotype 1 were treated for 48 weeks. Patients with genotype 2 or 3 were treated for 24 weeks and 32 weeks to 36 weeks if their HCV RNA level was undetectable after four weeks (RVR4) or eight weeks (RVR8) of therapy, respectively. If RVR8 was not achieved, the treatment was continued for 48 weeks.

Results: There were no dropouts or dose reductions within the first 12 weeks of treatment. SVR status was available for 20 patients and adequate serum for viral kinetics analyses was available for 17 patients. Eighty per cent of the patients achieved SVR (50% genotype 1; 100% genotypes 2 and 3). The week 8 viral load remained elevated for all genotype 1 nonresponders.

Discussion: High effectiveness rates were seen, particularly in patients with HCV genotype 2 and 3 who were treated for shorter durations. HCV viral loads after eight weeks of therapy helped distinguish patients with HCV genotype 1 who would respond to therapy.

Introduction: Hepatitis C virus (HCV) infection is potentially curable, but the sustained virological response (SVR) has been shown to be lower in patients coinfected HIV. A single-centre experience treating individuals with HCV and HIV coinfection is reported.

Methods: Twenty-one patients who received standard doses of pegylated interferon with weight-based dosing of ribavirin (mean 14.3 mg/kg) were retrospectively reviewed. Qualitative HCV polymerase chain reaction (PCR) was performed prospectively every four weeks if the patient remained HCV PCR positive. All patients with HCV genotype 1 were treated for 48 weeks. Patients with genotype 2 or 3 were treated for 24 weeks and 32 weeks to 36 weeks if their HCV RNA level was undetectable after four weeks (RVR4) or eight weeks (RVR8) of therapy, respectively. If RVR8 was not achieved, the treatment was continued for 48 weeks.

Results: There were no dropouts or dose reductions within the first 12 weeks of treatment. SVR status was available for 20 patients and adequate serum for viral kinetics analyses was available for 17 patients. Eighty per cent of the patients achieved SVR (50% genotype 1; 100% genotypes 2 and 3). The week 8 viral load remained elevated for all genotype 1 nonresponders.

Discussion: High effectiveness rates were seen, particularly in patients with HCV genotype 2 and 3 who were treated for shorter durations. HCV viral loads after eight weeks of therapy helped distinguish patients with HCV genotype 1 who would respond to therapy.

Introduction: L’infection par le virus de l’hépatite C (VHC) se soigne, mais on a observé que la réponse virologique soutenue (RVS) est plus faible chez les patients co-infectés par le VIH. Les chercheurs rendent compte de l’expérience monocentrique du traitement de personnes co-infectées par le VHC et le VIH.

Méthodologie: Les chercheurs ont procédé à l’analyse rétrospective de 21 patients qui avaient reçu des doses standard d’interféron pégylé associées à une dose de ribavirine fondée sur le poids (moyenne de 14,3 mg/kg). La réaction en chaîne de la polymérase (PCR) qualitative du VHC était exécutée de manière prospective toutes les quatre semaines si celle-ci révélait que le patient demeurait positif au VHC. Tous les patients ayant un VHC de génotype 1 ont été traités pendant 48 semaines. Les patients ayant le génotype 2 ou 3 ont été traités pendant 24 semaines et 32 à 36 semaines si leur taux de VHC dans l’ARN n’était plus décelable au bout de quatre semaines (RVR4) ou de huit semaines (RVR8) de traitement, respectivement. Si on ne parvenait pas à une RVR8, le traitement était maintenu pendant 48 semaines.

Résultats: Il n’y a pas eu d’abandon ou de réduction des doses dans les 12 premières semaines du traitement. Les chercheurs connaissaient la RVS de 20 patients et les analyses sériques pertinentes de la cinétique virale de 17 patients. Quatre-vingts pour cent des patients ont obtenu une RVS (50 % des cas de génotype 1; 100 % des cas de génotypes 2 et 3). La huitième semaine, la charge virale demeurait élevée pour tous les non-répondants de génotype 1.

Exposé: Les chercheurs ont observé un taux d’efficacité élevé, particulièrement chez les patients ayant un VHC de génotype 2 ou 3 qui avaient été traités moins longtemps. La charge virale du VHC au bout de huit semaines de traitement contribuait à faire ressortir les patients ayant un VHC de génotype 1 qui répondaient au traitement.

Keywords: Coinfection; Hepatitis C virus; Human immunodeficiency virus; Sustained virological response; Treatment; Viral load.

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Figures

Figure 1)
Figure 1)
Study cohort. HCV Hepatits C virus; SVR Sustained virological response
Figure 2)
Figure 2)
Hepatitis C virus (HCV) viral kinetics from 0 to 12 weeks for HIV-coinfected patients starting treatment for HCV. SVR Sustained virological response
See this image and copyright information in PMC

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