Efficacy of Hepatitis C treatment with pegylated interferon plus ribavirin may be higher among HIV-coinfected patients receiving nevirapine.
There are a growing number of people coinfected with HIV and Hepatitis C, and these coinfected patients have higher HCV RNA loads and more rapid progression of fibrosis than HCV-monoinfected patients. The choice of the HIV antiretroviral regimen may influence plasma HCV-RNA and the efficacy of treatment for hepatitis C in coinfected patients (Mira, 2008).
Today, Jose Mira, from Seville, Spain presented results from a retrospective study that evaluated antiretroviral regimen predictors of sustained virologic response (SVR) among patients with Hepatitis C/HIV coinfection treated with pegylated interferon (peg-IFN) plus ribavirin (RBV).
Patients with HIV/HCV coinfection who received hepatitis C treatment of peg-IFN and RBV and who also received antiretroviral therapy for HIV containing either nevirapine (NVP) or lopinavir/ritonavir (LPV/r) with NRTIs tenofovir plus either lamivudine or emtricitabine, were identified at twenty hospitals in Spain.
The two groups were similar in terms of age, HCV genotype and initial CD4, but differed as fewer of those receiving NVP had cirrhosis (6% versus 32%, P = 0.001). Also, patients receiving LPV/r were more likely to have higher baseline HCV-RNA, 73% over ≥600000 IU/ml compared with 44% receiving NVP.
The rates of sustained virologic response after completion of HCV therapy were compared in the LPV/r (n=94) and NVP (n= 71) groups. A significantly lower SVR was noted among those receiving LPV/r, 37% vs. 56% receiving NVP (p=0.015). The difference in SVR was pronounced in patients with genotype 1 or 4 (43% of patients on NVP vs. 24% on LPV/n, p=0.04).
When evaluating those with initial HCV RNA ≥600000 IU/ml, 58% on NVP and 31% on LPV/r had an SVR. Furthermore, SVR rates did not differ by liver fibrosis stage suggesting that the baseline differences in the two groups were not likely to account for the differences in treatment efficacy between the groups.
References:
Mira JA, Lopez-Cortes LF, Vispo E, Tural C, et al. Concomittant nevirapine therapy is associated with higher efficacy of pegylated interferon plus ribavirin among HIV/hepatitis C virus-coinfected patients. Presented July 20, 2010 at the XVIII International AIDS Conference, Vienna, Austria. Abstract TUAB0101.
Mira J, et al. Efficacy of pegylated interferon plus ribavirin treatment in HIV/hepatitis C virus co-infected patients receiving abacavir plus lamivudine or tenofovir plus either lamivudine or emtricitabine as nucleoside analogue backbone. Antimicrob Chemother. 2008 Dec; 62(6):1365-73.
07/20/10
PRN Reports From AIDS 2010: Nevirapine Improves HCV Treatment Outcomes in HIV Coinfected Patients
Source: Reporting from Vienna, Austria for PRN News: Anita Radix MD, MPH and Susan Weiss FNP, AAHIVS