Hepatitis C virus (HCV) treatment uptake and changes in the prevalence of HCV genotypes in HIV/HCV‐coinfected patients

Abstract

The efficacy of current hepatitis C therapy in HIV/HCV-coinfected patients is largely dependent on HCV genotype. The annual prevalence of HCV genotypes/subtypes and their influence on HCV clearance with antiviral treatment were examined in a dynamic cohort of HIV/HCV-coinfected patients followed up in Madrid since 2000. Patients entered the cohort at first visit and left the cohort when HCV clearance was achieved with HCV therapy or when follow-up was interrupted for any reason, including death. A total of 672 HIV/HCV-coinfected patients constituted the cohort. The mean follow-up time was 5.5 years, corresponding to 4108 patient-years. Mean age at entry was 37 years, and 73% were men and 86% were intravenous drug users. Overall distribution of HCV genotypes was as follows: 57.1% HCV-1 (1a: 29.2%, 1b: 20.4%, unknown: 7.6%), 1.3% HCV-2, 25.4% HCV-3 and 15.9% HCV-4. A total of 274 (40.8%) patients were treated with peginterferon-ribavirin, of whom 116 (42.3%) achieved HCV clearance following 1-3 courses of therapy. The proportion of HCV-1/4 rose from 71.7% in 2000 to 76.8% in 2008, whereas the proportion of HCV-2/3 fell from 28.1% in 2000 to 23.2% in 2008. The yearly prevalence increased for HCV-1 (R(2) : 0.92, b: 0.59, P < 0.001) and HCV-4 (R(2) : 0.77, b: 0.33, P < 0.005) and conversely diminished for HCV-3 (R(2) : 0.94, b: -0.82, P < 0.001). In summary, the prevalence of HCV-1 and HCV-4 has increased over the last decade in HIV/HCV-coinfected patients, whereas conversely it has declined for HCV-3, in association with the wider use of HCV therapy (41%) in this population.

Prediction of response to pegylated interferon plus ribavirin in HIV/hepatitis C virus (HCV)-coinfected patients using HCV genotype, IL28B variations, and HCV-RNA load

“…Furthermore, the HCV genotype and the baseline viral load are well studied predictors of SVR and might have caused a selection bias in the population of this study. However, the genotype HCV GT 1 distribution reported herein is similar to that reported in epidemiological studies conducted in this environment [26][27]. Therefore, we believe that our results are extrapolable to the global HIV/HCV-coinfected population since no significant deviation can be expected.…”

“…However, response rates of 20% and 60% are reasonable cut-off points to consider patients as good or poor responders. In addition, the proportion of genotype 4 carriers was considerably small, which reflects the HCV genotype distribution in our environment [26][27] and studies with larger sample sizes of this subset are necessary. In fact, an ongoing multicentric study in our area aims to recruit more patients bearing HCV genotype 4 (unpublished data).…”

Cambios en la prevalencia y distribución genotípica de la coinfección por el virus de la hepatitis C en pacientes infectados por el virus de la inmunodeficiencia humana

“…Este resultado es relativamente inesperado, pues el tratamiento de la hepatitis C hasta muy recientemente era la biterapia con interferón pegilado y ribavirina (peg-IFN/RBV), que es considerablemente menos efectivo para el tratamiento de los genotipos 1 y 4 que frente a los genotipos 3 8 . Por ello, hubiera sido lógico encontrar un incremento de genotipos más difíciles de curar en el segundo periodo, como observaron Medrano et al 9 . Nuestros resultados señalan la necesidad reevaluaciones de la frecuencia relativa de genotipos del VHC entre los portadores del VIH.…”

The Different Distribution of Hepatitis C Virus Genotypes in Eastern Black Sea Region of Turkey

“…Recently, hepatitis C treatment has been increasingly used in some areas and/or risk community; it would be expected to have an impact on the most recent distribution of HCV genotypes [19]. While genotype 3a is very sensitive to interferon medication compared to the other genotypes, genotype 1b is more resistant to interferon in HCV genotypes [20,21].…”