HIV-positive individuals with chronic hepatitis C coinfection who previously received unsuccessful interferon-based therapy for hepatitis C rarely achieve a sustained treatment response when retreated with pegylated interferon plus dose-adjusted ribavirin, according to a study presented to the Third International Workshop on HIV and Hepatitis Coinfection in Paris last week.
The single-centre, open-label study was conducted in Barcelona and included 21 individuals. All had previously received unsuccessful anti-hepatitis C therapy consisting of interferon plus ribavirin. Investigators wished to see if using 48 weeks of pegylated interferon plus a dose of ribavirin adjusted by weight would achieve a sustained virological response.
A total of 21 patients were included in the study, 18 were men, 15 were former injecting drug users, 81% were infected with the harder-to-treat hepatitis C genotypes 1 and 4, and the median age was 44 years.
At baseline, 71% of patients had a median hepatitis C viral load above 800,000 copies/ml, a threshold associated with poorer treatment response. Cirrhosis was diagnosed in 52%. Anti-HIV therapy was being used by 90% of the patients, with 81% having an undetectable HIV viral load.
Individuals received the current standard of care for hepatitis C - pegylated interferon with dose-adjusted ribavirin. Treatment response was measured after 24 weeks, and individuals with an undetectable hepatitis C viral load at this point continued their therapy for a further 24 weeks.
Only nine patients achieved an undetectable viral load at week 24, and only four of these patients went on to achieve a sustained virological response.
Side-effects resulted in 15 patients adjusting their dose of pegylated interferon. In addition, three patients had their dose of ribavirin changed because of adverse events. However, no patient stopped treatment early because of side-effects.
The investigators suggest that more aggressive treatment strategies should be used in coinfected patients who previously failed interferon-based therapies. This could include a longer duration of therapy with pegylated interferon and ribavirin and the use of growth factors.
Crespo M et al. Efficacy of pegylated-interferon alfa 2b and ribavirin for re-treatment of chronic HCV infection in HIV-coinfected patients failing a previous course of standard interferon alfa-2b plus ribavirin. Third International Workshop on HIV and Hepatitis Coinfection, abstract 5, Paris, 2007.