Coinfection

EASL 2010: Pegylated Interferon plus Ribavirin Works as Well in HIV/HCV Coinfected Patients with Cirrhosis

HIV/HCV coinfected patients with cirrhosis who received standard chronic hepatitis C therapy using pegylated interferon plus ribavirin had a sustained virological response rate similar to that of non-cirrhotic coinfected patients, according to research presented at the 45th Annual Meeting of the European Association for the Study of the Liver (EASL 2010) last month in Vienna.

HIV/HCV coinfected individuals tend to experience more rapid liver disease progression than patients with HCV alone, and respond less well on average to interferon-based therapy. Severe liver fibrosis or cirrhosis is a risk factor for poor response, but people with the most advanced liver disease stand to gain the most benefit from successful therapy. Treatment of HIV/HCV coinfected people with cirrhosis has not been extensively studied, however, and some clinicians are hesitant to treat this population due to concern about poor response and adverse events.

M.C. Mendes-Correa and colleagues performed a retrospective analysis comparing response rates and treatment-related toxicity in 310 HIV/HCV coinfected patients (39 with liver cirrhosis and 217 without) who received pegylated interferon plus ribavirin at 10 centers in Brazil between 2005 and 2007, and who had a liver biopsy taken within 1 year before starting treatment.

Results

• Participants with cirrhosis were younger on average than non-cirrhotic patients (42 vs 45 years, respectively), were more likely to have hard-to-treat HCV genotypes 1 or 4 (79% vs 63%), and more often had a history of previous hepatitis C treatment (49% vs 23%).
• In an adjusted intent-to-treat analysis, sustained virological response (SVR) rates (continued undetectable HCV viral load 6 months after competing treatment) did not differ significantly between cirrhotic and non-cirrhotic patients (23% vs 30%, respectively; P = 0.3).
• Similarly, patients with cirrhosis were not significantly more likely than non-cirrhotic patients to discontinue treatment prematurely due to adverse events or for other reasons (39% vs 29%; P = 0.2).
• In a multivariate analysis, presence of cirrhosis was significantly associated with thrombocytopenia (low platelet count), older age, having HCV genotype 2 or 3, and a history of previous hepatitis C treatment.

"In this group of coinfected patients, treatment of chronic hepatitis C with [pegylated interferon plus ribavirin] showed similar rates of SVR in compensated cirrhotic and non-cirrhotic patients," the investigators concluded.

"Premature discontinuation of therapy and toxicity (other than thrombocytopenia) were not associated with presence of cirrhosis," they added.

Hospital das Clinicas-Infectious Diseases Department, Sao Paulo University Medical School, Sao Paulo; CRTAIDS, Sao Paulo; Clinica de Especialidades, Sao Bernardo do Campo; Infectious Diseases Department, Sao Paulo University Medical School, Ribeirao Preto; CRTAIDS, Bauru; Instituto de Infectologia Emilio Ribas, Sao Paulo; Infectious Diseases Department, Medical School-Espirito Santo Federal University, Vitoria; CRTAIDS, Brasília; CRTAIDS, Diadema; Epidemiology and Statistics Laboratory, Sao Paulo University Medical School, Sao Paulo; Infectious Diseases Department, Medical School-Sao Paulo Federal University, Sao Paulo, Brazil.

5/28/10

Reference

MC Mendes-Correa, MH da Silva, JFC Figueiredo, and others. Pegylated interferon plus ribavirin: an efficacious and well-tolerated treatment regimen for HIV-HCV co-infected patients with hepatitis C virus related cirrhosis. 45th Annual Meeting of the European Association for the Study of the Liver (EASL 2010). Vienna, Austria. April 14-18, 2010. (Abstract).