Friday, September 28, 2012

Don't rule out IFN/ribavirin for HIV patients with hep C cirrhosis: study

NEW YORK (Reuters Health) - In HIV patients with hepatitis C, compensated cirrhosis should not be considered a contraindication to therapy with pegylated interferon (peg-IFN) and ribavirin, researchers say.

As is the case in patients without HIV, peg-IFN plus ribavirin is more effective against hep C in HIV patients who are free of cirrhosis, the researchers reported online September 5th in Clinical Infectious Diseases.

"In spite of that, this antiviral combination still leads to an appreciable rate of sustained virological response in cirrhotic patients carrying HCV genotype 3," Dr. Jose A. Mira and Dr. Juan A. Pineda of Hospital Universitario de Valme in Seville, Spain, who helped conduct the new study, told Reuters Health.

While compensated liver cirrhosis is known to predict worse response to IFN plus ribavirin in patients who are only infected with HCV, the researchers note, just one small study has looked at the issue in individuals who are co-infected with HIV. That study, which included 41 patients, found similar rates of sustained viral response (SVR) for patients with and without cirrhosis.

To investigate further, Dr. Mira, Dr. Pineda and their colleagues looked at 629 HIV/HCV co-infected patients receiving treatment with peg-IFN and ribavirin, all of whom had undergone a liver biopsy or liver stiffness measurement within a year of beginning treatment. Twenty-eight percent had cirrhosis.

Intention-to-treat analysis showed SVR in 25% of patients with cirrhosis and 39% of cirrhosis-free patients (p=0.001). Among the patients with cirrhosis, SVR occurred in 14% of those with HCV genotype 1; 47% of patients with HCV genotype 2-3; and 30% of patients with HCV genotype 4.

Part of the difference in response could have been due to the fact that 17% of the cirrhotic patients discontinued treatment due to adverse events, compared to 8% of those without cirrhosis, the researchers note.

"We think that the efficacy of pegylated interferon plus ribavirin in HIV/HCV co-infected patients with HCV genotype 4 depends primarily on other known predictors of response to HCV therapy in these patients, specifically the IL28B genotype," Dr. Mira and Dr. Pineda said via email.

"In fact, in another study carried out in our research group (Mira JA et al. AIDS 2012; 26:1721-1724), we found that only IL28B genotype CC was associated with sustained virological response in this population," they continued. "There are data supporting that interferon-mediated immune response against HCV, which is associated with IL28B genotype, has a different impact depending on HCV genotype. To confirm this hypothesis, a study with a higher number of HCV-4-infected patients would be required."

Despite the fact that patients co-infected with HIV and HCV who have compensated cirrhosis are a "hard-to-cure population," the researchers add, HCV therapy should be a priority in these patients, "given that once decompensated cirrhosis emerges, death due to liver failure occurs in the short-term."

Clin Infect Dis 2012.

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