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Abacavir-Containing HAART Reduces the Chances for Sustained Virological Response to Pegylated-Interferon pllus Ribavirin in HIV-Infected Patients with Chronic Hepatitis C
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Reported by Jules Levin
ICAAC Sept 17-20, 2007, Chicago
Eugenia Vispo1, Pablo Barrreirro1, Ivana Maida1, Juan A Pineda2, Jose A Miira2, Ignacio Santos3, Jose A Giron4,, Dolorres Merino5, Antonio Rivero6 and Vicente Sorriano1
1Hospiital Carlos III, Madrid; 2Hospittall de Valme, Seviillla; 3Hospittall La Princesa, Madrid;
4Hospital Puerta dell Mar, Cádiz; 5Hospittal Juan Ramon Jimenez, Huelva;
6Hospital Reina Sofía, Cordoba. Spain
The author does not make a good case, but she suggests that abacavir may interact with ribavirin and reduce ribavirin levels in blood or intracellularly.
AUTHOR CONCLUSIONS
Treatment with pegIFN-RBV plus weight-adjusted doses of RBV provides SVR in 38% of HIV infected patients
Baseline HCV-RNA, HCV-genotype and plasma levels of RBV have a strong influence in the rate of SVR
The use of ABC as part of HAART is associated with reduced chances for SVR
The negative effect of ABC was
--particullarly evident in patients with lower exposure to RBV
--in part influenced by greater degrees of liver fibrosis at baseline
As RBV and ABC share phosphorylation pathways, a possible intracellular interaction between both dugs may explain these findings
INTRODUCTION
--HIV infection reduces the chances for SVR to pegIFN-RBV
--Negative impact of some antiretrovirals
--ZDV plus RBV increased risk of anemia
--ddI toxicity is enhanced due to intracellular interaction with RBV
--No intracellular interaction between RBV and ZDV, 3TC, d4T1
--Little data regarding intracellular knetics when RBV is combined with
ABC or TDF
Aim of the study:
Influence of the antiretroviral regimen on the risk for nonresponse
or relapse to pegIFN plus RBV
1 Rodriguez-Torres M., Antimicrob Agents Chemother 49:3997-4008
MATERIAL AND METHODS
Multicenter retrospective analysis of consecutive HIV/HCV infected patients
HCV therapy, first-line in all cases
--PegIFN (alpha-2a or alpha-2b) plus RBV (adjusted to body weight) for 48 weeks
--Liver biopsy pre-therapy
--RBV plasma levels at week 4 and 12
--EVR assessment, 2 log rule applied
--No growth factors used
HIV therapy, naive or under HAART:
remained unmodified along the period of anti-HCV therapy
RESULTS
Demographics. 40% had advanced liver fibrosis; HIV well controlled; HIV RNA 2.24 logs; 35% <50 c/ml; CD4 count 567.
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