Re-treatment of HIV/HCV Coinfected Patients with Pegylated Interferon plus Ribavirin

		SUMMARY: About one-third of previously treated HIV/HCV coinfected patients who did not achieve sustained virological response (SVR) with suboptimal interferon-based therapy can be cured with a second course of pegylated interferon plus ribavirin, according to a Spanish study published in the January 23, 2010 advance online edition of the Journal of Acquired Immune Deficiency Syndromes.

By Liz Highleyman

Approximately half of people with chronic hepatitis C virus (HCV) infection -- and a somewhat higher proportion of HIV/HCV coinfected people -- do not attain SVR (continued undetectable HCV viral load 24 weeks after completing treatment) with a first course of standard-of-care therapy consisting of pegylated interferon plus ribavirin. The success rate is even lower for people initially treated with a suboptimal regimen, for example conventional rather than pegylated interferon, or interferon monotherapy without ribavirin.

Pablo Labarga from Hospital Carlos III in Madrid and colleagues evaluated the safety and efficacy of standard-of-care treatment for coinfected patients who did not achieve sustained response or relapsed after prior suboptimal therapy.

The study included 52 chronic hepatitis C patients. Most (78%) had hard-to-treat HCV genotypes 1 or 4 and about half (56%) had advanced but compensated liver fibrosis. Prior suboptimal regimens included interferon monotherapy (20%), conventional interferon plus ribavirin (29%), and pegylated interferon plus fixed-dose 800 mg/day ribavirin (51%). Overall, 61% were prior non-responders and 39% were prior relapsers.

All participants were treated with 180 mcg/week pegylated interferon alpha-2a (Pegasys) plus weight-adjusted doses of ribavirin (1000 mg/day if < 75 kg [about 165 lb] or 1200 mg/day if 75 kg) for 48 weeks.

Results

	The overall sustained virological response rate was 30.8%.
	As expected, SVR was significantly less likely in people with HCV genotypes 1 or 4 (19.5%) compared with genotypes 2 or 3 (72.7%).
	In a multivariate analysis, the only independent predictors of SVR were:
	Genotype 2 or 3 (odds ratio 22.2; P = 0.003); Higher ribavirin trough concentration, or lowest level between doses (odds ratio 3.9; P = 0.01).

Based on these findings, the researchers concluded that re-treatment with pegylated interferon alpha-2a plus weight-based ribavirin for 12 months results in HCV clearance in nearly one-third of HIV/HCV coinfected patients who failed a prior suboptimal course of hepatitis C therapy.

"Patients with HCV genotypes 2/3 and those with ribavirin plasma trough levels above 2.07 mcg/mL show the highest chances of SVR," they added.

Department of Infectious Diseases and Pharmacology Unit, Hospital Carlos III, Madrid, Spain; HIV Unit, Hospital San Pedro, Logroño, Spain.

2/2/10

Reference
P Labarga, E Vispo, P Barreiro, and others. Rate and Predictors of Success in the Retreatment of Chronic Hepatitis C Virus in HIV/HCV-Coinfected Patients With Prior Nonresponse or Relapse. Journal of Acquired Immune Deficiency Syndromes (Abstract). January 23, 2010 (Epub ahead of print).