Are
HIV Positive People More Likely to Relapse after Completion of Hepatitis C Treatment
with Pegylated Interferon plus Ribavirin? By
Liz Highleyman
Prior studies have indicated that HIV
positive people coinfected with hepatitis C
virus (HCV) tend to experience more rapid liver disease progression and respond
less well to interferon-based therapy.
As reported at the XVII International AIDS Conference
this month in Mexico City, Spanish researchers hypothesized that since the efficacy
of pegylated interferon plus ribavirin
therapy is reduced in HIV positive patients,
HIV infection might be associated with a greater risk -- but delayed speed --
of HCV relapse after HCV RNA suppression at the end of treatment (EOT).
The
investigators retrospectively compared participants in 2 cohorts of hepatitis
C patients -- one HIV positive (n = 361), the other HIV negative (n = 243) --
treated at Hospital Carlos III in Madrid between January 2001 and January 2008.
The present study analyzed 253 (119 coinfected, 134 HCV
monoinfected) anti-HCV treatment-naive patients who completed at least 48
weeks of pegylated interferon plus weight-based ribavirin and who had undetectable
HCV RNA (<10 IU/mL) at the end of treatment.
Compared with the HCV monoinfected
group, the HIV-HCV coinfected
patients were younger (41 vs 46 years), more likely to be male (74% vs 58%),
less likely to have hard-to-treat HCV
genotypes 1 or 4 (70% vs 80%), and had more advanced
liver fibrosis.
The investigators categorized patients as early relapsers
within 12 weeks after the end of treatment, late relapsers between 12 and 24 weeks
after completing treatment, and very late relapse more than 24 weeks after the
end of treatment. Typically, individuals who have continued undetectable HCV RNA
24 weeks after completing treatment are classified as achieving sustained virological
response (SVR), which is widely regarded as a "cure" -- at least in HIV negative
individuals.
Results •
Of the 253
patients in the analysis, 170 were considered to have achieved SVR, 12 had insufficient
follow-up, and 71 experienced HCV relapse.
•
41 of 134 HIV-HCV
coinfected patients (30.6%) experienced post-treatment HCV relapse, compared with
30 of 119 HCV monoinfected individuals (25.5%).
•
Among the 41
HIV-HCV coinfected relapsers, 20 (47.8%) relapsed between the end of treatment
and post-treatment week 12, 19 (46.3%) between post-treatment weeks 12 and 24,
and 2 (4.9%) after post-treatment week 24.
•
Among the 30
HCV monoinfected relapsers, the corresponding numbers were 16 (53.3%), 9 (30.0%),
and 5 (16.7%) respectively.
•
Among HIV-HCV
coinfected patients, having HCV genotypes 1-4 vs 2-3 was significantly associated
with HCV relapse (P < 0.01).
•
Among the very
late relapsers, HCV recurrence was detected between post-treatment weeks 30 and
105.
•
All very late
relapsershad HCV genotype 1, except one who had genotpe 4.
Based
on these findings, the investigators concluded that incidence of HCV relapse "does
not differ significantly" in HCV monoinfected and HIV-HCV coinfected patients,
although it "tends to be more frequent" in coinfected individuals. Further, they
added, time to relapse also does not differ significantly depending on HIV status.
Since very late relapse remains rare, they stated that "24 weeks of follow-up
is still warranted to confirm SVR."
Hospital Carlos III, Infectious
Diseases, Madrid, Spain; Hospital La Princesa, Infectious Diseases, Madrid, Spain;
Hospital de Navarra, Infectious Diseases, Pamplona, Spain.
8/19/08
Reference
P Barreiro, M Nunez, I Santos, and others. HCV
relapses upon completion of peg-interferon plus ribavirin in HIV-infected patients:
rate, timing and predictors. XVII International AIDS Conference (AIDS 2008).
Mexico City. August 3-8, 2008. ( Abstract
THAB0202) |
