HCV viral decline at week 2 of Peg-IFN-alpha-2a/RBV therapy as a predictive tool for tailoring treatment in HIV/HCV genotype 1 co-infected patients

• Published in: PloS one 2014-06, Vol.9 (6), p.e99468
• Main Authors: Rivero-Juarez, Antonio, López-Cortés, Luis F, Camacho, Angela, Torres-Cornejo, Almudena, Gordon, Ana, Ruiz-Valderas, Rosa, Torre-Cisneros, Julian, Pineda, Juan A, Viciana, Pompeyo, Rivero, Antonio
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Antiretroviral drugs; Antiviral Agents - administration & dosage; Biopsy; Clinical medicine; Coinfection - drug therapy; Coinfection - virology; Female; Genotype; Genotype & phenotype; Genotypes; Hepacivirus - drug effects; Hepatitis; Hepatitis C - drug therapy; Hepatitis C - pathology; Hepatitis C - virology; Hepatology; HIV; HIV Infections - drug therapy; HIV Infections - pathology; HIV Infections - virology; Human immunodeficiency virus; Humans; Interferon; Interferon-alpha - administration & dosage; Liver; Male; Medicine and health sciences; Middle Aged; Patients; Polyethylene glycol; Polyethylene Glycols - administration & dosage; Predictions; Recombinant Proteins - administration & dosage; Ribavirin; Ribavirin - administration & dosage; Ribonucleic acid; RNA; Therapy; Treatment Outcome; Viral Load; α-Interferon
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0099468

Optimizing HCV genotype 1 therapy in terms of response prediction and tailoring treatment is undoubtedly the cornerstone of treating HIV co-infected patients in clinical practice. Accordingly, our aim was to analyze the predictive value of HCV viral decline for sustained virological response (SVR), measured at a time point as early as week 2 of therapy with pegylated interferon alpha-2a plus ribavirin (Peg-IFN/RBV). Previously untreated HIV/HCV genotype 1 co-infected patients were included in this study. The HCV RNA titer was measured at week 2 after starting treatment with Peg-IFN/RBV. The likelihood of reaching SVR when HCV RNA viral titers declined at week 2 was evaluated relative to predictive baseline factors. A total of 192 HIV/HCV genotype-1 co-infected patients were enrolled in the study and began therapy. One hundred and sixty-three patients completed a full course of Peg-IFN/RBV treatment for 2 weeks and 59 of these (36.2%) reached SVR. An HCV RNA viral load decline of ≥1.5 log IU/mL at week 2 had the maximum positive predictive value for SVR (83.3%; 95% CI: 68.5%-92.9%) and was identified as the strongest independent predictive factor for reaching SVR across all baseline predictive factors. HCV viral decline at week 2 had a high predictive value for identifying patients with a high and low likelihood of reaching SVR using dual therapy, regardless of strong predictive baseline factors. This finding may be useful for developing a predictive tool to help tailor HCV genotype 1 therapy in HIV co-infected patients.