HIV-positive patients who receive therapy for acute HCV can be cured with just 24 weeks of therapy

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HIV-positive individuals with acute hepatitis C may be able to clear the infection with just 24 weeks of therapy, Dutch research published in the online edition of AIDS suggests.

The retrospective study involved 50 HIV-positive gay men with acute hepatitis C who received care at two hospitals in Amsterdam.

Patients at one hospital were provided with hepatitis C therapy lasting 24 weeks, whereas individuals at the second hospital received the standard 48 weeks of treatment.

Glossary

acute infection

The very first few weeks of infection, until the body has created antibodies against the infection. During acute HIV infection, HIV is highly infectious because the virus is multiplying at a very rapid rate. The symptoms of acute HIV infection can include fever, rash, chills, headache, fatigue, nausea, diarrhoea, sore throat, night sweats, appetite loss, mouth ulcers, swollen lymph nodes, muscle and joint aches – all of them symptoms of an acute inflammation (immune reaction).

retrospective study

A type of longitudinal study in which information is collected on what has previously happened to people - for example, by reviewing their medical notes or by interviewing them about past events. 

pegylated interferon

Pegylated interferon, also known as peginterferon, is a chemically modified form of the standard interferon, sometimes used to treat hepatitis B and C. The difference between interferon and peginterferon is the PEG, which stands for a molecule called polyethylene glycol. The PEG does nothing to fight the virus. But by attaching it to the interferon (which does fight the virus), the interferon will stay in the blood much longer. 

cure

To eliminate a disease or a condition in an individual, or to fully restore health. A cure for HIV infection is one of the ultimate long-term goals of research today. It refers to a strategy or strategies that would eliminate HIV from a person’s body, or permanently control the virus and render it unable to cause disease. A ‘sterilising’ cure would completely eliminate the virus. A ‘functional’ cure would suppress HIV viral load, keeping it below the level of detection without the use of ART. The virus would not be eliminated from the body but would be effectively controlled and prevented from causing any illness. 

sustained virological response (SVR)

The continued, long-term suppression of a virus as a result of treatment. In hepatitis C, refers to undetectable hepatitis C RNA after treatment has come to an end. Usually SVR refers to RNA remaining undetectable for 12 or 24 weeks after ending treatment and is considered to be a cure (SVR12 or SVR24).

There were no significant differences in rates of hepatitis C clearance (a sustained virological response [SVR], or negative hepatitis C viral load six months after the completion of therapy) between the two groups of patients.

“This suggests that 24 weeks of treatment might be sufficient,” comment the authors.

There is an ongoing epidemic of sexually transmitted hepatitis C in HIV-positive gay men in northern Europe. Routine HIV care should include regular monitoring of liver function as well as hepatitis C testing for individuals who are at risk of the infection. This means that many hepatitis C infections are diagnosed in the acute stage.

Earlier research has shown that treating acute hepatitis C infection in HIV-positive patients can achieve high rates of cure.

Therapy normally consists of weekly pegylated interferon and daily doses of weight-based ribavirin.

Side-effects are common and can be unpleasant. Therefore investigators from Amsterdam wanted to see if the duration of therapy could be shortened from the standard 48 weeks to just 24 weeks.

They therefore designed a retrospective study involving HIV-positive gay men diagnosed with acute hepatitis C infection between 2003 and 2009.

Most (58%) of patients received 48 weeks of treatment, whereas the remaining 42% received treatment lasting 24 weeks.

The impact of treatment on hepatitis C viral load after four and twelve weeks is a major predictor of longer-term outcomes. Therefore the investigators monitored treatment responses at these time points, as well as at the end of therapy, and six months after its completion.

Treatment was stopped early by six patients (12%), either because of a lack of response or side-effects.

At the end of treatment, 88% of patients had an undetectable viral load. Six individuals subsequently relapsed, meaning that 76% of patients still had undetectable viral load six months after the completion of therapy and their hepatitis C infection was therefore cured.

“The sustained virological response rate…in this study confirms that treatment of HCV infection can be successful in HIV-infected patients when started in the acute phase, and should encourage clinicians to treat this complicated patient group,” write the authors.

A treatment response at week four was associated with significantly better rates of cure (p = 0.043).

Individuals who received 48 weeks of therapy had twice the chance of being cured. However, this could have been down to chance, as the difference in outcomes with patients who received the shorter treatment regimen was not significant (adjusted odds ratio, 2.32; 95% CI, 0.39-13.97). 

“The shorter regimen would be of great advantage for patients, since both peginterferon and ribavirin can cause serious side-effects,” suggest the researchers who acknowledge that their study was limited by its small sample size.

Nevertheless, the authors conclude, “the results of this retrospective cohort of HIV-infected MSM with acute HCV infection demonstrates that acute HCV infection in this coinfected population can be very effective and 24 weeks treatment may be sufficient.”

References

Lambers AEF et al. Treatment of acute hepatitis C virus infection in HIV-infected MSM: the effect of treatment duration. AIDS 25: online edition, doi: 10.1097/QAD.0b013e3283480144, 2011.