Rates and predictors of response to anti‐viral treatment for hepatitis C virus in HIV/HCV co‐infection in a nationwide study of 619 patients

• Published in: Alimentary pharmacology & therapeutics 2013-12, Vol.38 (11-12), p.1373-1384
• Main Authors: Ioannou, G. N., Scott, J. D., Yang, Y., Green, P. K., Beste, L. A.
• Format: Article
• Language: English
• Subjects: Alanine transaminase; Antiviral Agents - therapeutic use; Biological and medical sciences; CD4 Lymphocyte Count; Coinfection - drug therapy; Coinfection - virology; Erythropoietin - therapeutic use; Female; Genotype; Hepacivirus - genetics; Hepatitis C virus; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - virology; HIV Infections - drug therapy; HIV Infections - virology; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Interferon-alpha - therapeutic use; Male; Medical sciences; Middle Aged; Ribavirin - therapeutic use; RNA, Viral - analysis; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Viral hepatitis; Viral Load
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/apt.12524

Summary Background The effectiveness of anti‐viral treatment for hepatitis C virus (HCV) in HIV/HCV co‐infected patients in ‘real world’, clinical practice is unclear. Aims To determine the rates and predictors of sustained virological response (SVR) to anti‐viral treatment for HCV with pegylated interferon (PEG‐IFN) and ribavirin in HIV/HCV co‐infected patients. Methods We identified all HIV/HCV co‐infected patients who received anti‐viral treatment with PEG‐IFN and ribavirin in the Veterans Affairs healthcare system nationally between 2002 and 2009 (n = 665). Results Sustained virological response was achieved in 21.6% overall, 16.7% among patients with genotype 1 HCV (n = 491) and 44% among patients with genotype 2 or 3 HCV (n = 116). Among genotype 1‐infected patients, characteristics that were negatively associated with SVR independently included baseline HCV viral load >2 million IU/mL [adjusted odds ratio (AOR) 0.41, 95% CI 0.2–0.7], Black race [AOR 0.56 (0.3–0.96)], diabetes [AOR 0.42 (0.2–0.9)], baseline anaemia [AOR 0.42 (0.2–0.97)], serum aspartate aminotransferase/alanine aminotransferase ratio ≥1.2 [AOR 0.48 (0.2–0.97)] and use of zidovudine [AOR 0.41 (0.2–0.9)]; characteristics positively associated with SVR included a starting dose of ribavirin ≥1000–1200 mg/day [AOR 2.0 (1.1–3.7)] and erythropoietin use during treatment [AOR 2.9 (1.6–5.0)]. Among genotype 2 or 3 infected patients, only erythropoietin use was an independent predictor of SVR [AOR 3.1 (1.2–7.8)], while a starting dose of ribavirin >800 mg/day was not associated with SVR. Conclusions Sustained virological response rates achieved with PEG‐IFN and ribavirin in HIV/HCV co‐infected patients are low in clinical practice. The use of erythropoietin was the most important, modifiable factor associated with SVR.