Response to Antivirals for HCV in HIV/HCV Co-infection
Response to Antivirals for HCV in HIV/HCV Co-infection
Background The effectiveness of anti-viral treatment for hepatitis C virus (HCV) in HIV/HCV co-infected patients in 'real world', clinical practice is unclear.
Aims To determine the rates and predictors of sustained virological response (SVR) to anti-viral treatment for HCV with pegylated interferon (PEG-IFN) and ribavirin in HIV/HCV co-infected patients.
Methods We identified all HIV/HCV co-infected patients who received anti-viral treatment with PEG-IFN and ribavirin in the Veterans Affairs healthcare system nationally between 2002 and 2009 (n = 665).
Results Sustained virological response was achieved in 21.6% overall, 16.7% among patients with genotype 1 HCV (n = 491) and 44% among patients with genotype 2 or 3 HCV (n = 116). Among genotype 1-infected patients, characteristics that were negatively associated with SVR independently included baseline HCV viral load >2 million IU/mL [adjusted odds ratio (AOR) 0.41, 95% CI 0.2–0.7], Black race [AOR 0.56 (0.3–0.96)], diabetes [AOR 0.42 (0.2–0.9)], baseline anaemia [AOR 0.42 (0.2–0.97)], serum aspartate aminotransferase/alanine aminotransferase ratio ≥1.2 [AOR 0.48 (0.2–0.97)] and use of zidovudine [AOR 0.41 (0.2–0.9)]; characteristics positively associated with SVR included a starting dose of ribavirin ≥1000–1200 mg/day [AOR 2.0 (1.1–3.7)] and erythropoietin use during treatment [AOR 2.9 (1.6–5.0)]. Among genotype 2 or 3 infected patients, only erythropoietin use was an independent predictor of SVR [AOR 3.1 (1.2–7.8)], while a starting dose of ribavirin >800 mg/day was not associated with SVR.
Conclusions Sustained virological response rates achieved with PEG-IFN and ribavirin in HIV/HCV co-infected patients are low in clinical practice. The use of erythropoietin was the most important, modifiable factor associated with SVR.
Hepatitis C virus (HCV) co-infection occurs in 20–30% of HIV-infected patients. It is the most important cause of chronic liver disease in HIV-infected patients. Complications of chronic liver disease (cirrhosis, hepatocellular carcinoma, liver failure) have become leading causes of death in HIV/HCV co-infected patients due to a dramatic increase in the prevalence of HCV-related cirrhosis and hepatocellular carcinoma and a decrease in HIV-related deaths since the introduction of highly active antiretroviral treatment. Treatment of HCV co-infection should, therefore, be a crucial aspect of care in HIV-infected patients.
Limited data describe the effectiveness of anti-viral treatment for HCV in HIV/HCV co-infected patients in 'real world', clinical settings. Only a small proportion of those who receive pegylated interferon (PEG-IFN) and ribavirin, the current standard of care, achieved sustained virological response (SVR) (21–35%). 'Triple therapy' regimens, which include a protease inhibitor (PI) in addition to PEG-IFN and ribavirin, increase SVR by 30–40% in HCV mono-infected patients with genotype 1 infection. However, they are not yet approved for routine use in HIV/HCV co-infected patients.
We sought to determine the rates and predictors of response to HCV anti-viral treatment among HIV/HCV co-infected patients in the Veterans Affairs (VA) healthcare system. These findings could be used to propose strategies to improve anti-viral treatment in clinical practice. The VA healthcare system is an ideal setting for this study, as the largest integrated healthcare system in the United States, providing long-term, comprehensive care for a large population of HIV/HCV co-infected patients.
Abstract and Introduction
Abstract
Background The effectiveness of anti-viral treatment for hepatitis C virus (HCV) in HIV/HCV co-infected patients in 'real world', clinical practice is unclear.
Aims To determine the rates and predictors of sustained virological response (SVR) to anti-viral treatment for HCV with pegylated interferon (PEG-IFN) and ribavirin in HIV/HCV co-infected patients.
Methods We identified all HIV/HCV co-infected patients who received anti-viral treatment with PEG-IFN and ribavirin in the Veterans Affairs healthcare system nationally between 2002 and 2009 (n = 665).
Results Sustained virological response was achieved in 21.6% overall, 16.7% among patients with genotype 1 HCV (n = 491) and 44% among patients with genotype 2 or 3 HCV (n = 116). Among genotype 1-infected patients, characteristics that were negatively associated with SVR independently included baseline HCV viral load >2 million IU/mL [adjusted odds ratio (AOR) 0.41, 95% CI 0.2–0.7], Black race [AOR 0.56 (0.3–0.96)], diabetes [AOR 0.42 (0.2–0.9)], baseline anaemia [AOR 0.42 (0.2–0.97)], serum aspartate aminotransferase/alanine aminotransferase ratio ≥1.2 [AOR 0.48 (0.2–0.97)] and use of zidovudine [AOR 0.41 (0.2–0.9)]; characteristics positively associated with SVR included a starting dose of ribavirin ≥1000–1200 mg/day [AOR 2.0 (1.1–3.7)] and erythropoietin use during treatment [AOR 2.9 (1.6–5.0)]. Among genotype 2 or 3 infected patients, only erythropoietin use was an independent predictor of SVR [AOR 3.1 (1.2–7.8)], while a starting dose of ribavirin >800 mg/day was not associated with SVR.
Conclusions Sustained virological response rates achieved with PEG-IFN and ribavirin in HIV/HCV co-infected patients are low in clinical practice. The use of erythropoietin was the most important, modifiable factor associated with SVR.
Introduction
Hepatitis C virus (HCV) co-infection occurs in 20–30% of HIV-infected patients. It is the most important cause of chronic liver disease in HIV-infected patients. Complications of chronic liver disease (cirrhosis, hepatocellular carcinoma, liver failure) have become leading causes of death in HIV/HCV co-infected patients due to a dramatic increase in the prevalence of HCV-related cirrhosis and hepatocellular carcinoma and a decrease in HIV-related deaths since the introduction of highly active antiretroviral treatment. Treatment of HCV co-infection should, therefore, be a crucial aspect of care in HIV-infected patients.
Limited data describe the effectiveness of anti-viral treatment for HCV in HIV/HCV co-infected patients in 'real world', clinical settings. Only a small proportion of those who receive pegylated interferon (PEG-IFN) and ribavirin, the current standard of care, achieved sustained virological response (SVR) (21–35%). 'Triple therapy' regimens, which include a protease inhibitor (PI) in addition to PEG-IFN and ribavirin, increase SVR by 30–40% in HCV mono-infected patients with genotype 1 infection. However, they are not yet approved for routine use in HIV/HCV co-infected patients.
We sought to determine the rates and predictors of response to HCV anti-viral treatment among HIV/HCV co-infected patients in the Veterans Affairs (VA) healthcare system. These findings could be used to propose strategies to improve anti-viral treatment in clinical practice. The VA healthcare system is an ideal setting for this study, as the largest integrated healthcare system in the United States, providing long-term, comprehensive care for a large population of HIV/HCV co-infected patients.
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