HIV-positive patients coinfected with hepatitis C virus (HCV) should be given up to 18 months of anti-HCV therapy (rather than the standard six months), to prevent a high rate of relapse, according to Spanish research presented to the 43rd Interscience Conference on Antimicrobial Agents and Chemotherapy in Chicago on September 16th. Investigators stress, however, that because of the risk of unpleasant side-effects, additional therapy should only be considered for individuals who show an early response to treatment and that patients who are not responding to treatment after twelve weeks should stop anti-HCV therapy early.
Investigators led by Vincent Soriano of Instituto de Salud Carlos III, Madrid, conducted an analysis of the records of 89 HIV-HCV coinfected patients who completed six months of anti-HCV therapy consisting of pegylated interferon and ribavirin. A reduction in hepatitis C viral load of over two logs was seen in 58% of patients after twelve weeks of therapy. However, only 56% of these individuals achieved a sustained virological response (HCV PCR- negative six months after completing six months of anti-HCV treatment). None of the patients who achieved a sustained virological response had seen a drop in their HCV viral load of less than two logs by week twelve of therapy.
Relapses were seen in a third of patients who completed treatment, and response to treatment was not determined by the HCV genotype which a patient was infected with. Individuals infected with the genotypes which normally show the best response to therapy (genotypes 2 and 3) were just as likely to relapse as those with genotypes 1/4, which respond less well to treatment.
The investigators believe that these findings have important implications for HCV treatment strategies in HIV-positive patients.
The success of anti-HCV therapy should be assessed, the investigators recommend, after twelve weeks. If an individual has failed to achieve a reduction in their HCV viral load of at least two logs at this time, then HCV therapy should be discontinued given the high incidence of side-effects and poor likelihood of the patient achieving a sustained virological response. This approach is already widely favoured.
In patients who do respond to treatment, the subsequent relapse rate is high. Because of this, consideration should be given to extending the length of therapy from the six months normally used to twelve months for patients with genotypes 2/3, and twelve to 18 months for patients infected with genotypes 1/4.
Soriano V et al. Clinical implications of the slower clearance of HCV-RNA under interferon plus ribavirin in patients with HIV and hepatitis C virus 43rd ICAAC, abstract H-1718, Chicago, September 14 - 17th, 2003.