imageBoston—The Liver Meeting 2012 featured the latest in research, treatment guidelines and advances in the field of hepatology. Here, we highlight some the most compelling presentations related to treatment for patients infected with the hepatitis C virus (HCV) and HIV.

A Shortfall in Statin Use.
A study from the University of North Carolina at Chapel Hill suggests that providers are hesitant to prescribe statins to patients with dyslipidemia and chronic liver disease, despite data and guidelines supporting the safe use of the drugs in this patient population.

The cross-sectional study identified 1,198,221 patients with dyslipidemia. Statin use was compared in patients with HCV without cirrhosis, patients with compensated cirrhosis of any etiology and a group of controls without liver disease. The investigators found that statins were prescribed to 1,055 (28.7%) of the HCV-infected patients, 1,092 (34.1%) of the patients with compensated cirrhosis and 710,564 (59.6%) of control patients. Patients with HCV or compensated cirrhosis thus were significantly less likely than controls to receive statins (odds ratio, 0.31; 95% confidence interval, 0.29-0.32). The authors recommended increased education to change providers’ perceptions of statin hepatoxicity risk among patients with chronic liver disease.

“This study confirms that statins are underused in the HCV population and those with liver cirrhosis. As pharmacists, we can and should do a better job in educating patients and physicians about the safety of statins in this population,” said specialty pharmacist Janet Nguyen, PharmD, BCPS, vice president of network strategy at ModernHealth in Monrovia, Calif. “We should be doing a review of their medication profile and identifying opportunities to provide interventions for patients who should be put on a statin for their cardiovascular benefits.”

Response-Guided Therapy.
Current guidelines state that patients who are coinfected with HCV and HIV should be treated for 48 weeks, especially if polymerase chain reaction (PCR) tests for HCV remain positive at four weeks. But Canadian researchers presented data suggesting that response-guided therapy (RGT)—usually with pegylated interferon plus ribavirin (PR)—can significantly shorten the duration of therapy.

In the study, researchers at Toronto General Hospital used electronic medical records to identify all patients with HCV genotype 2 or 3 with HIV coinfection. PCR tests for HCV were performed every four weeks of drug therapy until a negative result (<50 IU/mL) was achieved.
In the intent-to-treat analysis, 23 of 35 patients were treated with the RGT protocol, and 20 patients completed their treatment. According to the researchers, only one patient needed the full 48 weeks of therapy to achieve a sustained virologic response (SVR)—a finding that was especially striking, considering the fact that less than half of the patients (nine) had a negative PCR HCV test at four weeks.

Based on the results, “the use of response-guided therapy allows [treatment] to be shortened in the majority of individuals” with HIV and HCV coinfection, the researchers concluded.

Positive Telaprevir Data.
Researchers from the University of Milan in Italy presented a study on the use of telaprevir (Incivek, Vertex) for patients with HCV genotype 1 with severe fibrosis or compensated cirrhosis. In the open-label, early-access program spanning 16 countries, patients were treated for 12 weeks with telaprevir and PR, followed by PR. At four weeks, 54% of patients had undetectable HCV RNA and at 12 weeks, 79% had undetectable viral loads. Serious adverse events occurred in 14% of patients, which is similar to rates from Phase III registration trials.

“The study results are consistent with what we have seen with other telaprevir studies,” commented Dr. Nguyen. “There is still a misnomer out in the community with what telaprevir can do for patients. It is a potential cure for HCV and people still don’t realize that. In this study, and other studies, even patients who had partial or null response to therapy in the past have hope with this therapy.”

Impact on Quality of Life.
Another study presented at The Liver Meeting evaluated the quality of life (QoL) in patients with chronic HCV who achieved SVR versus non-SVR after IFN-based HCV treatment. German researchers found that SVR had a significant effect on liver-related morbidity, and improved QoL and productivity. Specifically, 759 of 1,355 patients achieved SVR after first therapy and only three of those developed a liver-related clinical event compared with 31 non-SVR patients. Increased QoL (scored on the Short Form-36 Health Survey) and productivity (measured by higher frequency of employment, higher number of working hours and lower number of outpatient and inpatient visits after HCV treatment) also were significantly associated with patients who achieved SVR.
Source - Infectious Disease Special Edition

Future Therapies