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Continuing evidence to support the role of early kinetic monitoring in predicting sustained viral response for HIV/HCV co-infected patients

Background

Hepatitis C virus (HCV) is a major cause of chronic liver disease and requirement for liver transplantation. Shared acquisition risk factors mean that HIV co-infection is common. Co-infection has been shown to lead to faster progression of liver fibrosis. Combination therapy for HCV with pegylated interferon-alpha and ribavirin (pegIFN/RBV) results in comparable sustained virological response (SVR) rates for HIV/HCV co-infected patients vs. HCV mono-infected patients. Monitoring early viral kinetics, specifically baseline HCV viral load and week 4 HCV PCR can allow tailoring of treatment duration for specific patients and give prognostic information regarding primary treatment success.

Methods

98 HIV/HCV co-infected patients were commenced on treatment with pegIFN/RBV between 2001 and 2008. Early viral kinetic data was prospectively collected on 87/98 patients and these were included in our analysis. Genotype 2/3 infected patients were treated for 24 weeks. Weight-based dosing of RBV was used. Baseline characteristics and viral kinetics were analysed using Microsoft EXCEL and Epi-Info.

Summary of results

68/87 (78%) were male. 41/87 (47%) of patients had genotype 1/4 infection. On intention-to-treat analysis (ITT), overall SVR rate was 54%. Baseline mean HCV viral load was noted to be lower in those who achieved a SVR (6 × 106 iu vs. 14 × 106 iu; p < 0.05). On ITT analysis 38/87 (44%) achieved an undetectable HCV viral load at week 4 of treatment (rapid virological response [RVR]). Patients who achieved RVR were significantly more likely to achieve SVR (90% vs. 26%; p < 0.05. On-treatment analysis revealed that 100% of patients with RVR achieved SVR. Predictors of RVR were mean HCV viral load <6 × 106 at baseline (p < 0.05) and HCV genotype 2/3 (p < 0.05).

Conclusion

Monitoring of early viral kinetics can be used to accurately predict those patients who will achieve SVR, especially those for whom only 24 weeks of therapy is required.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Kieran, J., Jackson, A., Shea, D. et al. Continuing evidence to support the role of early kinetic monitoring in predicting sustained viral response for HIV/HCV co-infected patients. JIAS 11, P276 (2008). https://doi.org/10.1186/1758-2652-11-S1-P276

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  • DOI: https://doi.org/10.1186/1758-2652-11-S1-P276

Keywords

  • Sustained Virological Response
  • Sustained Virological Response Rate
  • Sustained Viral Response
  • Rapid Virological Response
  • Viral Kinetic