Interferon plus Ribavirin Works as Well in HIV/HCV Coinfected
Patients with Cirrhosis
coinfected patients with cirrhosis who received
standard chronic hepatitis C therapy using pegylated
interferon plus ribavirin had a sustained virological
response rate similar to that of non-cirrhotic coinfected
patients, according to research presented at the 45th
Annual Meeting of the European Association for the
Study of the Liver (EASL 2010)
last month in Vienna.
HIV/HCV coinfected individuals tend to experience more rapid
liver disease progression than patients with HCV
alone, and respond less well on average to interferon-based
therapy. Severe liver fibrosis
is a risk factor for poor response, but people with the most
advanced liver disease stand to gain the most benefit from successful
therapy. Treatment of HIV/HCV coinfected people with cirrhosis
has not been extensively studied, however, and some clinicians
are hesitant to treat this population due to concern about poor
response and adverse events.
M.C. Mendes-Correa and colleagues performed a retrospective
analysis comparing response rates and treatment-related toxicity
in 310 HIV/HCV coinfected patients (39 with liver cirrhosis
and 217 without) who received pegylated
interferon plus ribavirin at 10 centers in Brazil between
2005 and 2007, and who had a liver biopsy taken within 1 year
before starting treatment.
with cirrhosis were younger on average than non-cirrhotic
patients (42 vs 45 years, respectively), were more likely
to have hard-to-treat HCV genotypes 1 or 4 (79% vs 63%),
and more often had a history of previous hepatitis C treatment
(49% vs 23%).
an adjusted intent-to-treat analysis, sustained virological
response (SVR) rates (continued undetectable HCV viral load
6 months after competing treatment) did not differ significantly
between cirrhotic and non-cirrhotic patients (23% vs 30%,
respectively; P = 0.3).
patients with cirrhosis were not significantly more likely
than non-cirrhotic patients to discontinue treatment prematurely
due to adverse events or for other reasons (39% vs 29%;
P = 0.2).
a multivariate analysis, presence of cirrhosis was significantly
associated with thrombocytopenia (low platelet count), older
age, having HCV genotype 2 or 3, and a history of previous
hepatitis C treatment.
this group of coinfected patients, treatment of chronic hepatitis
C with [pegylated interferon plus ribavirin] showed similar
rates of SVR in compensated cirrhotic and non-cirrhotic patients,"
the investigators concluded.
"Premature discontinuation of therapy and toxicity (other
than thrombocytopenia) were not associated with presence of
cirrhosis," they added.
Hospital das Clinicas-Infectious Diseases Department, Sao
Paulo University Medical School, Sao Paulo; CRTAIDS, Sao Paulo;
Clinica de Especialidades, Sao Bernardo do Campo; Infectious
Diseases Department, Sao Paulo University Medical School, Ribeirao
Preto; CRTAIDS, Bauru; Instituto de Infectologia Emilio Ribas,
Sao Paulo; Infectious Diseases Department, Medical School-Espirito
Santo Federal University, Vitoria; CRTAIDS, Brasília;
CRTAIDS, Diadema; Epidemiology and Statistics Laboratory, Sao
Paulo University Medical School, Sao Paulo; Infectious Diseases
Department, Medical School-Sao Paulo Federal University, Sao
MC Mendes-Correa, MH da Silva, JFC Figueiredo, and others. Pegylated
interferon plus ribavirin: an efficacious and well-tolerated
treatment regimen for HIV-HCV co-infected patients with hepatitis
C virus related cirrhosis. 45th Annual Meeting of the European
Association for the Study of the Liver (EASL 2010). Vienna,
Austria. April 14-18, 2010. (Abstract).