JAC Advance Access published online on June 21, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn262
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Original research |
Efficacy of pegylated interferon and ribavirin for retreatment of chronic HCV infection in HIV co-infected patients failing a previous standard interferon-based regimen
1 Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain 2 Infectious Diseases Unit, Hospital Universitario de Valme, Sevilla, Spain 3 Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain 4 Internal Medicine Department, Hospital Torrecárdenas, Almería, Spain 5 Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario Puerta del Mar, Cádiz, Spain 6 Infectious Diseases Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain 7 Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain 8 Infectious Diseases Unit, Hospital Universitario Reina Sofía, Córdoba, Spain 9 Internal Medicine Department, Hospital Juan Ramón Jiménez, Huelva, Spain 10 Liver Unit, Department of Medicine, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Spain
Received 28 February 2008; returned 25 March 2008; revised 24 April 2008; accepted 3 June 2008
* Corresponding author. Tel: +34-630150090; Fax: +34-934282762; E-mail: mcrespo{at}vhebron.net
Background: Combination of pegylated interferon (Peg-IFN) and ribavirin is the standard treatment for HCV infection in HIV co-infected patients. However, data available on the efficacy of this therapy in co-infected patients who failed a former interferon-based regimen are limited.
Methods: We analysed the efficacy and safety of the Peg-IFN alfa-2a or alfa-2b plus ribavirin combination in a multicentre observational cohort study including 54 HCV/HIV co-infected patients who had failed to respond to or relapsed on interferon-based treatment. The primary efficacy endpoint was the proportion of patients who achieved a sustained virological response (SVR), defined as HCV RNA <50 IU/mL 24 weeks after completion of therapy.
Results: By intention-to-treat analysis, 30% of the patients achieved an SVR. Viral eradication by genotype was 18.9% (7/37) genotype 1; 57.1% (8/14) genotype 3 and 33.3% (1/3) genotype 4. The only independent predictor of SVR was genotype 3 (odds ratio: 5.3; 95% confidence interval: 1.4–19.8). Fourteen (38%) patients with genotype 1 had undetectable viral load at week 48 of treatment. Nevertheless, 50% of them relapsed during the follow-up period. Severe adverse events or progression of HIV infection did not occur during the study; however, 39% of the patients required Peg-IFN dose reduction because of intolerance or haematological toxicity.
Conclusions: Combined Peg-IFN and ribavirin achieved a substantial rate of SVR in HCV/HIV co-infected patients who failed a prior standard interferon-based regimen. The decision to retreat any co-infected patient should be individual-based. More aggressive strategies may be necessary to avoid the high relapse rate observed among patients with genotype 1.
Key Words: HCV non-responders , HCV retreatment strategies , HIV co-infection
Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd).
Grupo para el Estudio de las Hepatitis Víricas de la Sociedad Andaluza de Enfermedades Infecciosas (SAEI).