HCV kinetics, quasispecies, and clearance in treated HCV-infected and HCV/HIV-1-coinfected patients with hemophilia

Authors

  • Norah J. Shire,

    Corresponding author
    1. The University of Cincinnati Division of Digestive Diseases, Cincinnati, OH
    2. The University of Cincinnati Division of Epidemiology and Biostatistics, Cincinnati, OH
    • The University of Cincinnati, 231 Albert Sabin Way, ML 0595, Cincinnati, OH 45267
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    • fax: 513-558-1744

  • Paul S. Horn,

    1. The University of Cincinnati Department of Mathematical Sciences, Cincinnati, OH
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  • Susan D. Rouster,

    1. The University of Cincinnati Division of Digestive Diseases, Cincinnati, OH
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  • Sandra Stanford,

    1. The University of Cincinnati Division of Digestive Diseases, Cincinnati, OH
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  • M. Elaine Eyster,

    1. The Pennsylvania State University College of Medicine, Division of Hematology/Oncology, Hershey, PA
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  • Kenneth E. Sherman,

    1. The University of Cincinnati Division of Digestive Diseases, Cincinnati, OH
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  • Multicenter Hemophilia Cohort HCV Study Group

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    • The Hemophilia HCV Study Group: Rita Barsky, Ph.D., National Hemophilia Foundation; James Goedert, M.D., National Cancer Institute; Zach Goodman, M.D., Ph.D., Armed Forces Institute of Pathology; Margaret J. Koziel, M.D., Harvard Medical School/Beth Israel Deaconess Hospital; Cindy Leissinger, M.D., Tulane University; Gail Long, Pennsylvania State University, Hershey Medical Center; Jeffrey Sanders, Pennsylvania State University, Hershey Medical Center; James Steinberg, MD, Emory University.


  • Potential conflict of interest: Dr. Sherman is a consultant for, is on the Speakers' Bureau and received grants from Roche.

Abstract

Hepatitis C virus (HCV) treatment response rates remain low in HCV/HIV-1-coinfected individuals compared with those with HCV alone. Persons with inherited coagulation disorders have high rates of HCV and HIV-1 infection, but HCV treatment trials in this patient population are scarce. We hypothesized that differences by infection status in HCV viral kinetics would be associated with differences in HCV quasispecies complexity over time and with treatment response disparities. Coinfected and monoinfected patients were enrolled in a treatment trial for pegylated-interferon alpha-2a (peg-IFN) + ribavirin. Patients were treated for 48 weeks and followed for an additional 24. Quantitative HCV RNA was tested at multiple times during and after treatment. Viral kinetic parameters associated with response were estimated with a mathematical model. Quasispecies emergence was determined via heteroduplex complexity assay. Twenty-two patients were HCV RNA-positive at baseline, with no significant demographic or virological differences by infection status. Five of eleven (45%) of monoinfected and 3 of 11 (27%) of coinfected patients achieved sustained viral response (SVR). Peg-IFN efficacy (ε) of 90% or greater was associated with probability of end-of-treatment response (ETR) (P = .001) and SVR (P = .06). Patients with SVR had lower baseline quasispecies complexity than those without SVR (P = .07). Those with ε of 90% or greater also had lower baseline complexity (P = .07). Coinfection status mediated changes in complexity over time (P = .04). In conclusion, low pretreatment quasispecies complexity may predict peg-IFN response; early peg-IFN response is critical for sustained HCV clearance and is altered in coinfection. Further studies are warranted. (HEPATOLOGY 2006;44:1146–1157.)

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