Wednesday, October 10, 2012

Cirrhotic patients coinfected with HIV, HCV less responsive to peg-IFN/RBV

Cirrhotic patients coinfected with HIV, HCV less responsive to peg-IFN/RBV

Mira JA. Clin Infect Dis. 2012;doi:10.1093/cid/cis779.

October 10, 2012
Treatment with pegylated interferon and ribavirin was less effective in patients with cirrhosis and coinfected with HIV and HCV than noncirrhotic patients in a recent study.

In a multicenter prospective cohort study, researchers evaluated 629 patients coinfected with HCV and HIV, including 175 with cirrhosis. All participants received treatment with pegylated interferon (peg-IFN) and ribavirin (RBV), and had undergone either a biopsy or liver stiffness measurement within 1 year of starting therapy. Follow-up included plasma HCV RNA measurement and assessment of adverse events, and occurred at least once every 4 weeks during the initial 24 weeks of treatment, then every 2 months until conclusion

In intention-to-treat analysis, sustained virological response (SVR) occurred in 38.9% of noncirrhotic patients compared with 25.1% of those with cirrhosis (P=.001 for difference). Per-protocol analysis of 521 patients indicated significantly more incidence of SVR among those without cirrhosis (46% of patients compared with 33%, P=.007), and lack of cirrhosis was associated with SVR via multivariate analysis (adjusted OR=2.02; 95% CI, 1.1-3.4). Patients with cirrhosis also were significantly more likely to discontinue treatment due to adverse events than noncirrhotic patients (17% of patients vs. 8%, P=.001).

SVR was more common in cirrhotic patients with HCV genotype 2-3 (47% of patients) than those with genotype 1 (14%) or 4 (30%), and researchers observed a significant association between SVR and HCV genotype 1 or 4 (aOR=8.9, 2.7-29). Other factors predictive of SVR included baseline liver stiffness measurements of less than 30 kPa (aOR=4.1, 1.02-16.7) and a baseline HCV viral load of 600,000 IU/mL or less (aOR=6.0, 1.8-2.0) (95% CI for all).

“Although HIV-infected patients with compensated HCV-related cirrhosis are a hard-to-cure population, HCV therapy is a priority in these patients,” the researchers wrote. “Because of this, HCV therapy with peg-IFN plus RBV should be recommended to patients with genotype non-1 until more effective drugs are available. New drugs are needed to improve the efficacy of HCV therapy in HIV/HCV coinfected patients with compensated liver cirrhosis.”

Disclosure: See the study for a full list of relevant disclosures.

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