Investigators
from Brazil designed a study to evaluate different prognostic
factors for obtaining sustained
virological response (SVR), or continued undetectable HCV
RNA 24 weeks after completion of treatment, in HCV monoinfected
and HCV/HIV confected individuals.
In this retrospective cohort study, the researchers reviewed medical
records from 59 HIV positive and 323 HIV negative genotype 1 chronic
hepatitis C patients treated with pegylated
interferon alfa-2a (Pegasys) or pegylated interferon alfa-2b (PegIntron)
plus 1000-1250 mg/day weight-adjusted ribavirin for 48 weeks.
They analyzed the effects on SVR of baseline HCV viral load >
600,000UI/mL, fibrosis stage, age > 40 years, and early virological
response (EVR) at week 12, looking at both complete (undetectable
HCV RNA) and partial (HCV RNA reduction of at least 2 logs) EVR.
Results
 |
High
baseline HCV viral load, more advanced fibrosis stage, and
older age were all associated with a decreased likelihood
of SVR. |
|
Achieving
EVR predicted a higher likelihood of sustained response. |
|
Patients
with compete EVR had substantially higher SVR rates than
those with partial EVR. |
|
At
each stratum, however, HIV/HCV coinfected patients had lower
SVR rates than those with HCV alone: |
|
<
600,000 IU/mL: |
| |
|
Fibrosis
stage F1+F2 (mild-to-moderate): |
|
<
40 years: |
 |
Partial
EVR: 26% HCV monoinfected vs 14% HIV/HCV
coinfected; |
|
Complete
EVR: 80% monoinfected vs 65% coinfected. |
|
| >
40 years: |
|
Partial
EVR: 17% monoinfected vs 9% coinfected;
|
|
Complete
EVR: 70% monoinfected vs 53% coinfected. |
|
|
|
| |
|
Fibrosis
stage F3 (advanced): |
|
<
40 years: |
|
Partial
EVR: 17% monoinfected vs 9% coinfected; |
|
Complete EVR: 71% monoinfected vs 53%
coinfected. |
|
| >
40 years: |
|
Partial
EVR: 11% monoinfected vs 6% |
|
Complete
EVR: 59% monoinfected vs 41% coinfected. |
|
|
|
|
>
600,000 IU/mL: |
|
Fibrosis
stage F1+F2: |
|
<
40 years: |
|
Partial
EVR: 19% monoinfected vs 10% coinfected; |
|
Complete
EVR: 73% monoinfected vs 56% coinfected. |
|
| >
40 years: |
|
Partial
EVR: 13% monoinfected vs 6% coinfected;
|
|
Complete
EVR: 62% monoinfected vs 44% coinfected. |
|
|
|
| |
|
Fibrosis stage F3: |
|
<
40 years: |
|
Partial
EVR: 13% monoinfected vs 7% coinfected; |
|
Complete
EVR: 63% monoinfected vs 45% coinfected. |
|
| >
40 years: |
|
Partial
EVR: 8% monoinfected vs 4% coinfected; |
|
Complete
EVR: 50% monoinfected vs 33% coinfected. |
|
|
|
| |
|
Fibrosis
stage F4: |
|
<
40 years: |
|
Partial
EVR: 6% monoinfected vs 3% coinfected; |
|
Complete
EVR: 43% monoinfected vs 27% coinfected. |
|
| >
40 years: |
|
Partial
EVR: 4% monoinfected vs 2% coinfected; |
|
Complete
EVR: 31% monoinfected vs 18 coinfected. |
|
|
|
|
SVR
rates ranged from a high of 80% for HCV monoinfected individuals
younger than 40 years with low baseline HCV RNA, mild-to-moderate
fibrosis, and complete EVR, to only 2% for HIV/HCV coinfected
patients older than 40 years with high baseline HCV RNA,
cirrhosis, and partial EVR. |
Based on these results, the investigators concluded, "Patients
with cirrhosis, HCV genotype 1, high viral load, [age] > 40
years, coinfected with HIV or not, will present a very low SVR
if [they] did not obtain negative [HCV RNA] in week 12 of treatment,
and should be evaluated for discontinuation."
Internal
Medicine, Hospital Nossa Senhora da Conceição,
Gastroenterology, Santa Casa de Porto Alegre, Hospital Nossa
Senhora da Conceição, Post-Graduation Course of
UFCSPA, Porto Alegre, Brazil.
4/23/10
Reference
PRL d Almeida, AAD Mattos, CV Tovo. Sustained virological response
(SVR) according the type of early virological response (EVR)
and other prognostic factors in monoinfected HCV and coinfected
HCV/HIV genotype 1 patients. 45th Annual Meeting of the European
Association for the Study of the Liver (EASL 2010). Vienna,
Austria. April 14-18, 2010. (Abstract).
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