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PegIFN/RBV May Be Less Effective in Acute HCV for HIV+
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Reported by Jules Levin
ABSTRACT
"Is the treatment of acute hepatitis C in HIV-positive individuals effective?"
IAS-Rio July 2005
TuPe1.1C10
Nelson M.1, Gilleece Y.1, Browne R.1, Asboe D.1, Atkins M.1, Mandalia S.1, Bower M.1, Gazzard B.1
1Chelsea & Westminster Hospital, London, United Kingdom
Introduction: To evaluate the effectiveness of treatment of acute hepatitis C infection in HIV-1 positive individuals.
Methods: Patients diagnosed with acute hepatitis C by positive HCV antibody test had sequential HCV RNA levels measured at 0, 4, 12, 24, 32 and 48 weeks. If HCV RNA positive at 12 weeks patients were offered pegylated interferon alpha-2b 1.5µg/Kg/week + weight adjusted ribavirin for 24 weeks. Patients with increasing HCV RNA VL were offered treatment earlier.
Results:
50 male homosexuals, mean age 37yrs, were identified: 44 via newly abnormal LFT's, 4 from sexual contact with HCV positive partner and 2 at
HIV seroconversion. 12 individuals became HCV RNA -negative spontaneously. This was significantly associated with a high baseline median CD4+
lymphocyte count (p=0.029), CD4+ lymphocyte count >500 (p=0.017) and lower HCV RNA VL (p=0.017).
27 patients accepted treatment, 16 (59%) of whom had a sustained virological response (SVR). This was associated with a higher peak mean ALT (p<0.001) but not with genotype--
--55% with genotype 1 (n=20) had an SVR, 65% had an ETR, End-Of-Treatment Response.
--But, 100% (n=4) of patients with non-1 genotype had an SVR.
Conclusions: SVR rates in HIV-positive patients treated acutely for hepatitis C are lower than in HIV negative subjects. A high percentage of individuals
seroconvert spontaneously.
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