Treatment for acute hepatitis C virus infection achieved a sustained virological response in almost two-thirds of HIV-positive gay men, according to data presented to the Third International Workshop on HIV and Hepatitis Coinfection in Paris on June 7th.
Dr Sanjay Bhagani of London’s Royal Free Hospital, told delegates that 60% of patients with the ‘hard-to-treat’ hepatitis C genotype 1 achieved a sustained virological response. Patients whose baseline hepatitis C viralload was below 800,000 copies/ml and who had a rapid response (an undetectable hepatitis C viral load after four weeks of treatment) to therapy were most likely to experience successful treatment.
Outbreaks of hepatitis C have been reported amongst HIV-positive gay men in several European countries. It is thought that most of these men acquired the infection sexually. Because of increasing incidence of the infection in HIV-positive patients, and due to ongoing uncertainties about the best time to start hepatitis C therapy, and the duration of therapy, investigators in the UK, France and Germany formed a collaborative study in early 2007 to determine the risk factors, natural history and optimal treatment strategies for hepatitis C infection in HIV-positive individuals.
Preliminary retrospective data, collected from four treatment centres between 1999 and early 2006 were presented to the Paris workshop.
A total of 161 cases of acute hepatitis C were diagnosed in HIV-positive gay men at these centres. The average age was 38 years and sexual transmission was suspected in 88%, with 15% having a recent infection with syphilis. Most of the patients (93%) had their infection diagnosed due to abnormal liver function tests, but 17% were tested for hepatitis C infection because of the presence of symptoms.
Anti-hepatitis C therapy was initiated by 144 individuals and 131 completed this treatment. Data on these individuals were presented.
The majority of patients (70%) had the hard-to-treat genotype 1, with a further 10% having the equally difficult-to-treat genotype 4.
Potent anti-HIV therapy was being taken by 70% of patients, and immune function was well preserved in the study population, median CD4 cell count being 444 cells/mm3 and 80% of individuals had a viral load below 400 copies/ml. The initiation of anti-hepatitis C therapy caused a change of HIV therapy in 38% of patients.
In all, 74% of patients took what is now considered to be the standard of care for coinfected patients (pegylated-interferon plus ribavirin). Treatment was started within twelve weeks of hepatitis C being diagnosed in 57% of patients.
A total of 16% of individuals stopped therapy within 20 weeks, mostly because of intolerable side-effects. Most individuals (51%) took between 20 – 28 weeks of anti-hepatitis C treatment with 33% taking over 28 weeks therapy. Most of the patients who received longer duration of treatment received their care at the Royal Free Hospital in London.
A sustained virological response was achieved by 64% of patients overall, and by 60% of patients with genotype 1, a result which Dr Bhagani found highly encouraging.
Unsurprisingly, infection with genotypes 2/3 was associated with a higher odds ratio of a sustained virological response, as was treatment with a combination of pegylated-interferon and ribavirin. An undetectable hepatitis C viral load at weeks four and twelve predicted a sustained treatment response. Patients whose baseline hepatitis C viral load was below 800,000 copies/ml were also more likely to have a successful response to treatment. Receiving less than 20 weeks of therapy predicted poorer treatment response.
A blood disorder related to hepatitis C therapy was observed in 10% of patients and 13% experienced depression, a recognised side-effect of pegylated-interferon.