|
HCV kinetic during the first 24 hours of treatment and its relationship with RVR/EVR in HCV/HIV coinfected patients
Presented by Natalia Laufer, Argentina.
N. Laufer1, F. Bolcic2, E. Socias1, M. Cabrini1, R. Reynoso1, N. Schvachsa2, H. Pérez1, H. Salomón2, P. Cahn1, J. Quarleri2
1Hospital Juan A Fernández, Infectious Diseases Unit, Buenos Aires, Argentina, 2National Reference Center for AIDS, School of Medicine, Buenos Aires University, Buenos Aires, Argentina
Background: In HIV/HCV coinfected patients(HHCP) receiving treatment with PEG-interferon and ribavirin (RBV), undetectable HCV RNA at week 4 (RVR) or a decay of 2log in HCV viral load (VL) at week 12 (EVR) are reliable predictors of sustained virological response. When patients chronically infected with HCV are treated with peg-IFN/RBV, a rapid VL decline within the first 24-48hs has been reported.
Objective: to evaluate the correlation between HCV-VL decay during the first 24 hours and early time point predictors of SVR (RVR or EVR).
Methods: Eleven HHCP followed during their treatment with PEG-interferon and RBV (adjusted to body-weight), had blood samples taken at baseline, 24 hours, 4 and 12 weeks. HCV viral load (Bayer VERSANT® HCV RNA 3.0 Assay) and HCV qualitative PCR (in house) were evaluated at each time point.
Results: Ten patients were on HAART, median CD4 count: 500 cell/ml(174-860).HCV Genotype distribution: G1 in 8patients, G2 in 1 and G3 in 2. Median VL at baseline was 660,862 IU/ml(70,105-2,462,780), and at 24 hours 84,561IU/ml (1,870-996,070). Three out of 11 patient achieved RVR, and 8/11 reached EVR. A HCV-VL decay of 98.7% and 85.4% was observed in patients achieving RVR and EVR respectively. In contrast in those who did not achieved these early time point responses had only a mean of 51.3% HCV-VL reduction in the first 24 hours.
Conclusions: A significant decline in HCV VL (greater to 85%) at 24 hours in HHCP treated with PEG-interferon plus ribavirin is associated with the achievement of either RVR or EVR. This very early time point assessment of viral declined could be of clinical relevance in those patients with severe toxicity during treatment to evaluate the risk/benefit of continuing therapy, as well as in resource-limited settings where treatment availability is limited, and a cost/benefit approach is warranted.
|