Therapeutical aspects and predictors of outcome for HIV/HCV co-infected patients treated with pegylated interferon plus ribavirin. Survey in an Italian university hospital
Abstract number: 1733_1390
Righi E., Bassetti M., Di Biagio A., Dentone C., Rosso R., Beltrame A., Mazzarello G., Ratto S., Viscoli C.
Introduction: One third of HIV-infected individuals worldwide suffers from chronic hepatitis C virus (HCV) infection. HCV therapy is a priority in coinfected patients because they have faster liver disease progression. We assess the impact of interferon and ribavirin combination therapy in a cohort of coinfected patients analysing specifically prognostic factors for outcome.
Methods: Patients enrolled in the study were all HIV/HCV patients who received HCV treatment between 2002 and 2006. Clinical data included: demographical data, HAART sitauation, HCV genotype and viral load (considering high rates >800,000 UI/mL). Primary outcome were early virological response (EVR) at week 12 and sustained virological response (SVR) 6 months after stopping treatment.
Results: Forty-four patients were treated for chronic hepatitis C during the four years period. Mean age was 41 years (SD±6.7) and 74% were males. Risk factors for co-infection were mainly related to intravenous drug abusers 32/43 (74%). Regarding immuno-virological situation, 51% had T-CD4+ count >500/mm3 at baseline, 79% showed no more than four HAART changes and only 19% had a CD4 nadir <200 cells/mm3. Genotype 3a represented 51%, while 40% were infected by genotype 1 and 9% by genotype 4. Only 16/43 (37%) were on HAART at baseline and half of the patients showed high HCV-RNA levels. Liver steatosis was present in 14/43 (33%) patients. Mean T-CD4+ count reduction was 175 cells/mm3 (33%), compared a T-CD4+ percentage reduction of 11%. High rates of HCV treatment discontinuation were present (63%), due to voluntary interruptions (52%), virological failure (26%), adverse events as cytopenia (11%) and others. Total EVR was 51%. The SVR was 30% in total, 38% and 24% for genotypes 3a and 1, respectively. Positive and negative predicting values of EVR were 60% and 90%. SVR was significantly lower in high HCV-RNA viral load group (c2 = 6, P < 0.0025), CD4 nadir <350 cells/mm3 (c2 = 3.26, P < 0.01) and <500 cells/mm3 (c2 = 3.94, P < 0.005) and in patients with genotype 1 and high viral load (c2 = 4.8, P < 0.005).
Conclusions: Factors as HCV viral load rates and genotype 1 have been confirmed to threaten the response to therapy. Patients with no EVR did not have any probability of SVR. There is a significant response rate if patients have a history of nadir >350 T-CD4+/mm3. High dropouts rates reported due to adverse event and voluntary discontinuations complicate HIV/HCV therapeutic management.
|Session name:||European Society of Clinical Microbiology and Infectious Diseases|
|Location:||ICC, Munich, Germany|
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