Rapid and early virological response to chronic hepatitis C treatment with IFN alpha 2b or PEG-IFN alpha 2b plus ribavirin in HIV/HCV co-infected patients

• Published in: Gut 2007-08, Vol.56 (8), p.1111-1116
• Main Authors: Payan, Christopher, Pivert, Adeline, Morand, Patrice, Fafi-Kremer, Samira, Carrat, Fabrice, Pol, Stanislas, Cacoub, Patrice, Perronne, Christian, Lunel, Francoise
• Format: Article
• Language: English
• Subjects: Hepatitis C virus; Human immunodeficiency virus
• ISSN: 0017-5749; 1468-3288
• DOI: 10.1136/gut.2006.106690

BACKGROUND: and aims: An algorithm based on a 2 log sub(10) decline in hepatitis C virus (HCV) RNA at week (W) 12 has been proposed in US and European recommendations for the management of patients with chronic hepatitis C treated with pegylated-interferon and ribavirin. METHODS: We examined rapid virological response (RVR; at W2 and W4 after the initiation of therapy) in HIV/HCV co-infected patients. Using HCV RNA measurements (Versant HCV RNA 3.0, Cobas Amplicor HCV 2.0), RVR was studied in 323 patients from the ANRS HC02 RIBAVIC trial, comparing interferon alpha 2b 3 MU x3/week with pegylated interferon alpha 2b 1.5 mu g/kg/week, each combined with ribavirin 800 mg/day over 48 weeks. RESULTS: The best positive and negative predictive values of sustained virological response (SVR) were obtained with an undetectable HCV RNA at W4 (97%) and with more than a 2 log sub(10) decrease at W12 (99%), respectively. Prediction of non-SVR was obtained in all patients by using HCV RNA cut-off levels above 460 000 IU/ml at W4 and above 39 000 UI/ml at W12 irrespective of the HCV genotype and arm of treatment. CONCLUSION: We propose a new algorithm based on RVR thresholds using HCV RNA that allows for excellent prediction of non-SVR as early as W4.