[WePp0304] Early Hepatitis C Viral Kinetics Prediction Of SVR In HIV/Hcv Co-Infected Patients Treated With Pegylated Interferon Alfa-2B (PEG-LFN) And Ribavirin (RBV)

3rd International AIDS Society Conference on HIV Pathogenesis and Treatment

Rio de Janeiro - July 24 - 27, 2005

EARLY HEPATITIS C VIRAL KINETICS PREDICTION OF SVR IN HIV/HCV CO-INFECTED PATIENTS TREATED WITH PEGYLATED INTERFERON ALFA-2B (PEG-LFN) AND RIBAVIRIN (RBV)

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. WePp0304

Neumann A.¹, Wu L.², McLaughlin M.², Koratich C.², Rehm C.², Masur H.³, Kottilil S.², Polis M.²
¹NIDDK, NIH, DHHS, Bethesda, MD, United States of America, ²LIR, NIAID, NIH, DHHS, Bethesda, MD, United States of America, ³CCMD, CC, NIH, DHHS, Bethesda, MD, United States of America

INTRODUCTION: HIV/HCV co-infected individuals have lower response to standard treatment of HCV than mono-infected patients. We studied the ability of early HCV kinetics to predict SVR to Peg-IFN and RBV in co-infected patients.

METHODS: HIV patients co-infected with HCV genotype 1 (11 Caucasian; 12 African-American or AA; mean CD4 612 cells/mm³) were treated with weekly PEG-IFN alfa-2b 1.5 µg/kg and RBV 1200 mg qd for 48 wks. HCV-RNA was quantified by bDNA assay. Viral kinetic parameters were compared to historical controls of HCV-gen-1, mono-infected Caucasians treated with PEG-IFN alfa-2b 0.5 µg/kg (N=27) or 3.0 µg/kg (N=26) and RBV 800 mg qd (Buti et al, Dig Dis Sci. 2002 Mar;47(3):562-3).

RESULTS: A rapid first phase viral decline was observed until day 1-3, which was different (P<0.05) between Caucasians and AA. A transient viral rebound was observed at days 3-7 in 22/23 patients, and at day 7 the mean viral decline from baseline was significantly (P<0.01) larger in Caucasians than AA. A second phase decline (weeks 1-4), was significantly (P<0.03) faster in Caucasians than in AA, and was correlated with viral load at day 3 (R=0.6, P<0.003). Viral kinetics did not significantly correlate with baseline ALT, CD4, HIV/HCV levels or age and gender. Viral kinetics in HIV/HCV co-infected Caucasians were not significantly different from historical mono-infected controls treated with Peg-IFN 0.5-1 µg/kg. SVR was achieved in 4 of 21 patients (19%). Lack of SVR could be predicted with NPV=100% by viral load >5 log cp/ml at day 28 (PPV=50%, Spec=77%) or at day 3 (PPV=67%, Spec=88%) independently of any baseline factor except genotype.

CONCLUSIONS: SVR in HIV/HCV co-infected patients treated with Peg-IFN alfa-2b and RBV in this study can be accurately predicted at 4 weeks, or even as early as 3 days, of treatment. With the limitation of comparison across studies, HCV kinetics among HIV co-infected patients seem to be predominantly influenced by race and HCV genotype.

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050724
Clinical | WePp0304 | Michael Polis
Hepatitis viruses

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