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HCV relapses upon completion of peg-interferon plus ribavirin in HIV-infected patients: rate, timing and predictors
Presented by Jose Medrano, Spain.
P. Barreiro1, M. Nuñez1, I. Santos2, J. Medrano1, J. Sola3, E. Vispo1, I. Maida1, P. Labarga1, L. Martín-Carbonero1, V. Soriano1
1Hospital Carlos III, Infectious Diseases, Madrid, Spain, 2Hospital La Princesa, Infectious Diseases, Madrid, Spain, 3Hospital de Navarra, Infectious Diseases, Pamplona, Spain
Background: The efficacy of peg-interferon plus ribavirin therapy for chronic hepatitis C is impaired in HIV patients. HIV infection could be associated with a greater risk of HCV relapse after complete HCV-RNA suppression at the end of treatment (EOT). However, dynamics of HCV relapse have not been well characterized in coinfected patients.
Methods: The PRESCO study recruited HIV-HCV coinfected patients exposed to peg-interferon alpha-2a plus ribavirin 1000-1200 mg/day. Patients having HCV-RNA levels <10 IU/mL at planned EOT were analyzed. Two main groups were established: patients with HCV-RNA relapse after EOT, at weeks 12 (early relapse) or 24 (late relapse), and those attaining sustained virological response (SVR).
Results: A total of 394 patients were included, of whom 262 (67.3%) achieved undetectable HCV-RNA at the EOT (48% for genotypes 1-4 versus 90% for genotypes 2-3; p<0.01). A total of 44 (17%) patients showed HCV relapse, 33 (24%) with genotypes 1-4 versus 16 (10%) with genotypes 2-3 (p=0.02). Multiple regression models (OR (95% CI) p) showed that HCV genotypes 1-4 (2.23 (0.90-5.50) 0.08), baseline serum HCV-RNA ³500,000 IU/mL (4.81 (1.52-15.22) 0.008), detectable HCV-RNA at week 4 (2.94 (1.22-7.09) 0.02) and concomitant antiretroviral use (2.71 (1.03-7.13) 0.04) were associated with HCV relapse, as compared with patients attaining SVR. HCV relapse occurred before week 12 after EOT in 41 (84%) patients, and later in the remaining 8 (16%) relapsers. While 94% of patients with genotypes 1-4 showed early relapse, it occurred in only 36% of genotypes 2-3 patients (p<0.01). In one G3 patient, relapse occurred at month 8 after EOT.
Conclusions: The rate of HCV relapses in HCV/HIV-coinfected patients treated with peg-interferon plus weight-based ribavirin is similar to that seen in HCV-monoinfected patients (17% PRESCO vs 13% Fried New Engl J Med 2002), but late relapses may be more common (17% PRESCO vs 2% Zeuzem J Hepatol 2003), particularly in G2-3 patients.
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