HIV/HCV Co-Infected Patients Respond Well to HCV Therapy
By Brian Boyle, MD
Due to the potential for rapid progression of liver disease related to hepatitis C virus (HCV) infection in HIV/HCV co-infected patients and the increasing rates of hepatic mortality in HIV-infected patients, treatment of HCV in patients with HIV may significantly improve the long-term morbidity and mortality of these patients. To this date, however, there is only limited data regarding the effectiveness of interferon (IFN) and ribavirin (RBV) combination therapy in HIV/HCV co-infected patients.
A prospective study by Bini and colleagues, presented at the 52nd AASLD meeting, evaluated the safety and efficacy of IFN alfa-2b and RBV combination therapy in HIV/HCV co-infected patients. They enrolled consecutive HIV/HCV co-infected patients who were treated with IFN alfa-2b 3 MU TIW in combination with 800 - 1200 mg/day of RBV. For each HIV/HCV co-infected patient enrolled, 2 HIV-negative, HCV-positive patients matched for genotype, HCV viral load, and the presence of cirrhosis were selected as controls. The duration of therapy in both groups was 24 weeks in patients with genotype 2 and 3 or up to 48 weeks in those with genotype 1. In patients with genotype 1, treatment was discontinued if HCV was still detectable at 24 weeks.
32 HIV/HCV co-infected patients (mean age 50.0 years; 62.5% black; 84.4% HCV genotype 1; mean HCV viral load 2.1 x 106 copies/mL; 21.9% with cirrhosis; and mean CD4+ T cell count 424 cells/mm3) were enrolled. Other than HIV infection, there were no significant differences between the 32 HIV/HCV co-infected patients and the 64 HCV positive patients enrolled in the study. Treatment with IFN and RBV did not result in significant decreases in CD4+ T cell counts or increases in HIV viral loads. There were no serious adverse events or deaths in either group. Of the HIV/HCV co-infected and HCV infected patients, 75% and 82.8% were able to complete therapy. Using an intent to treat analysis, the sustained virologic response (SVR) rate for co-infected and HCV infected patients with genotypes 2 and 3 was 40% and 50%, respectively, (p=1.00) and with genotype 1 was 18.5% and 22.2%, respectively (p=0.70).
The authors conclude from these data, "Combination therapy with IFN and RBV is safe and efficacious for the treatment of HCV in patients co-infected with HIV. Co-infected patients have a SVR that is no different from patients who are not infected with HIV." These data are encouraging and indicate that HIV-infected patients with relatively high CD4+ T cell counts should respond well to therapy for HCV.