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JAC Advance Access originally published online on May 10, 2005
Journal of Antimicrobial Chemotherapy 2005 55(6):824-827; doi:10.1093/jac/dki142
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions{at}oupjournals.org

Leading article

Role of viral kinetics under HCV therapy in HIV/HCV-coinfected patients

Angel Luis Ballesteros1, Daniel Fuster1, Ramon Planas2, Bonaventura Clotet1 and Cristina Tural1,*

1 HIV Clinical Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autónoma de Barcelona, Barcelona, Spain; 2 Hepatology and Gastroenterology Department, Hospital Universitari Germans Trias i Pujol, Universitat Autónoma de Barcelona, Barcelona, Spain

* Corresponding author. Tel: +34-93-497-88-87; Fax: +34-93-465-76-02; Email: ctural{at}ns.hugtip.scs.es

Patients coinfected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are less responsive to anti-HCV therapies and are at a higher risk of toxicity than HCV monoinfected patients. HCV viral kinetics is the basis for the study of response to interferon-based therapy and for predicting sustained virological response (SVR). A lack of early virological response (EVR; undetectable HCV RNA or a decrease of ≥2 log10 from baseline) after 12 weeks of pegylated interferon (peg-IFN) plus ribavirin (RBV) is an equally reliable predictor of lack of SVR in HIV/HCV-coinfected patients and in the monoinfected HCV population. Early stopping rules are particularly important in coinfected HIV/HCV patients, considering their low chances of response in the more difficult-to-treat HCV genotypes 1 and 4 (<30%). Several factors have been involved in this low efficacy, including higher baseline HCV viraemia, slower viral kinetics decay under interferon pressure and a defective immune substratum. A better understanding of HCV viral kinetics under HCV therapy may be the basis for assaying different peg-IFN plus RBV schedules, such as induction or extending strategies, and may help physicians to make tailored decisions for the management of their patients.

Keywords: HCV kinetics , early virological response , peg-IFN efficacy


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