Antiviral Treatment for Hepatitis C Virus in HIV/HCV Coinfected Patients
George N. Ioannou1,2, John D. Scot2, Yin Yang1, Pamela Green1, Lauren A. Beste1
1Veterans Affairs Puget Sound Health Care System, Seattle, WA; 2University of Washinqfon, Seattle, WA
Objectives We aimed to determine the rates and predictors of sustained virologic response (SVR) to antiviral treatment for hepatitis C virus (HCV) with pegylated interferon and ribavirin in HIV/HCV co-infected patients. Methods We identified all HIV/HCV co-infected patients who received antiviral treatment with pegylated interferon and ribavirin, the current standard of care, in the Veterans Affairs healthcare system nationally between 2002-2009 (n=665). Results Among 619 patients with available data, SVR was achieved in 21.6% overall, 16.7% among patients with genotype 1 HCV (n=491), and 44% among patients with genotype 2 or 3 HCV (n = 116). Among genotype 1 infected patients, characteristics that independently predicted failure to achieve SVR included baseline HCV viral load >2 million IU/ml (adjusted odds ratio [AOR] 0.41, 95% CI 0.2-0.7), Black race (AOR 0.56 [0.3-0.96]), diabetes (AOR 0.42 [0.2-0.9]), baseline anemia (AOR 0.42 [0.2-0.97]), serum AST/ALT ratio >1.2 (AOR 0.48 [0.2-0.97]) and use of zidovudine (AOR 0.41 [0.2-0.9]). Treatment characteristics that independently predicted achieving SVR in genotype 1-infected patients included a starting dose of ribavirin ≥1200mg/day, if weight ≥75Kg, or ≥1000mg/day, if weight <75Kg, (AOR 2.0 [1.1-3.7]) and erythropoietin use during treatment (AOR 2.9 [1.6-5.0]). Among genotype 2 or 3 infected patients, only erythropoietin use was an independent predictor of achieving SVR (AOR 3.1[1.2-7.8]), while a starting dose of ribavirin >800 mg/day was not associated with SVR. Conclusions SVR rates achieved with pegylated interferon and ribavirin in HIV/HCV co-infected patients are low in clinical practice. Erythropoietin use was the most important, modifiable factor associated with SVR. Higher starting ribavirin doses are necessary to achieve SVR for genotype 1 HCV (1000-1200 mg/day) than for genotype 2 and 3 HCV (800 mg/day).
John D. Scott - Advisory Committees or Review Panels: Vertex; Grant/Research Support: Gilead, Merck, Genentech, Vertex, Janssen; Speaking and Teaching: Gilead, Genentech, Vertex; Stock Shareholder: Merck
The following people have nothing to disclose: George N. Ioannou, Yin Yang, Pamela Green, Lauren A. Beste