October 7, 2013
SAN FRANCISCO — Factors including pretreatment hepatitis C RNA and ALT levels, CD4, age and race may predict acute HCV treatment response among HIV coinfected patients and could aid in determining when direct-acting antivirals should be added to interferon-based therapy, according to data presented at ID Week 2013.
Leah Bürke, MD, and colleagues from Weill Cornell Medical Center and the Icahn School of Medicine at Mount Sinai evaluated data collected from 75 patients coinfected with HIV and acute HCV treated with pegylated interferon and ribavirin (pIFN/R) between January 2004 and January 2013. Sustained virologic response data was available in 73 cases. All but five participants had HCV genotype 1.
Factors that predicted RVR in genotype 1 infection in multivariate analysis included: CD4 counts above 500 cells/mm3 (OR=4.8; P=.047), peak pretreatment ALT above 600 IU/mL (OR=5.7; P=.026) and baseline pretreatment HCV RNA of 1,000,000 IU/mL or lower (OR=17.2; P=.001 or less). Of the factors associated with SVR in multivariate analysis, RVR was the strongest predictor (OR=13.5; P=.003). Age of 40 years or younger also was predictive of SVR (OR=5.8; P=.01). Among a subset of patients with available IL28 genetic polymorphism data, the CC genotype was significantly predictive of SVR when included in the multivariate model.
“Since available direct-acting antivirals [DAAs] may increase drug interactions and side effects, predicting which patients will fail treatment with pIFN/R could better inform use of DAAs in this population,” the researchers wrote. “In patients with poor prognostic predictors … the addition of a DAA to pIFN/R should be considered from time of initiation of treatment or if no RVR is achieved.”