Impact of HIV infection on sustained virological response to treatment against hepatitis C virus with pegylated interferon plus ribavirin

Abstract

It is commonly accepted that human immunodeficiency (HIV) coinfection negatively impacts on the rates of sustained virological response (SVR) to therapy with pegylated interferon plus ribavirin (PR). However, this hypothesis is derived from comparing different studies. The aim of this study was to determine the impact of HIV coinfection on SVR to PR in one single population. In a multicentric, prospective study conducted between 2000 and 2013, all previously naïve hepatitis C virus (HCV)-infected patients who started PR in five Spanish hospitals were analyzed. SVR was evaluated 24 weeks after the scheduled end of therapy. Of the 1046 patients included in this study, 413 (39%) were coinfected with HIV. Three hundred and forty-one (54%) HCV-monoinfected versus 174 (42%) HIV/HCV-coinfected patients achieved SVR (p < 0.001). The corresponding figures for undetectable HCV RNA at treatment week 4 were 86/181 (47%) versus 59/197 (30%), p < 0.001. SVR was observed in 149 (69%) HCV genotype 2/3-monoinfected subjects versus 91 (68%) HIV/HCV genotype 2/3-coinfected subjects (p = 0.785). In the HCV genotype 1/4-infected population, 188 (46%) monoinfected patients versus 82 (30%) with HIV coinfection (p < 0.001) achieved SVR. In this subgroup, absence of HIV coinfection was independently associated with higher SVR [adjusted odds ratio (95% confidence interval): 2.127 (1.135-3.988); p = 0.019] in a multivariate analysis adjusted for age, sex, baseline HCV RNA load, IL28B genotype, fibrosis stage, and type of pegylated interferon. HIV coinfection impacts on the rates of SVR to PR only in HCV genotype 1/4-infected patients, while it has no effect on SVR in the HCV genotype 2/3-infected subpopulation.

Retrospective study of hepatitis C outcomes and treatment in HIV co-infected persons from the Australian HIV Observational Database

“…24,25 For pegylated interferon treatment, SVR rates of HIV/HCV co-infected patients are lower than those among HCV mono-infected patients. 26 SVR outcomes in mono-infected patients in Australia were 59.5% overall; 49.5% for genotype 1 and 69.6% for genotypes 2 and 3. 27 With the arrival of DAAs, these differences are likely to diminish.…”

HCV Cure and Reinfection Among People With HIV/HCV Coinfection and People Who Inject Drugs

“…The "real-world" efficacy of DAA therapy among people with HIV/HCV coinfection appears to be comparable to clinical trial efficacy [38][39][40][41]43]. In a population traditionally designated difficult to treat, given poor outcomes with pegylated interferon and ribavirin (SVR ≤ 30%) [44,45], high SVR12 (93%) was demonstrated among people with HIV/ HCV coinfection and cirrhosis enrolled in the French National Agency for Research on AIDS and Viral Hepatitis (ANRS) CO13 HEPAVIH cohort [40]. Of 189 treated (75% male, 58% HCV genotype 1, 16% Child-Pugh class B or C), the vast majority received 24 weeks of sofosbuvir in combination with an NS5A inhibitor, daclatasvir (65%), or ledipasvir (12%), with or without ribavirin.…”

Peginterferon still has a place in the treatment of hepatitis C caused by genotype 3 virus

“…However, more recently, Monje-Agudo et al . 15 specifically assessing SVR in GEN3 patients found no effect of HIV presence in the attainment of SVR. Much like these previous authors, we could not find an effect of co-infection by HIV on SVR rates in GEN3 patients.…”

“…Liver cirrhosis is considered an important indicator of poor CHC treatment outcome and low SVR rates 9 , 12 , 15 . However, this association was not observed in the present study, although a non-significant tendency in this direction did occur.…”