Treatment of Acute Hepatitis C Infection with Pegylated Interferon and Ribavirin in Patients Coinfected with Human Immunodeficiency Virus: A Systematic Review and Meta-Analysis

Abstract

Background/Aims: Of the 35 million human immunodeficiency virus (HIV)-positive patients worldwide, 10-40% are coinfected with chronic hepatitis C virus (HCV). Compared to HCV-monoinfected patients, those coinfected experience decreased spontaneous HCV clearance, accelerated liver fibrosis, and a decreased response to anti-HCV therapy. We conducted a meta-analysis to estimate the efficacy of treating acute HCV in HIV-positive patients with peginterferon and ribavirin combination therapy. Methods: Two authors independently searched MEDLINE and EMBASE (2014) for English articles, and reviewed bibliographies and abstracts from major liver and HIV conferences (2011-2013). Original studies featuring at least 10 treatment-naive, HIV-positive adults infected with acute HCV and treated with peginterferon and ribavirin were included. Analyses were calculated using a random-effects model. Heterogeneity was assessed using the Cochrane Q test (p < 0.05) and the I² statistic (>50%). Results: From 12 studies (450 patients), the pooled sustained virological response (SVR) was 71.4% (95% CI 64.7-77.4; Q statistic = 22.20, p = 0.023, I² = 50.44). The rapid virological response (RVR; 7 studies, 196 patients) was 47.4% (95% CI 40.6-54.7), and the early virological response (EVR; 9 studies, 283 patients) was 82.8% (95% CI 67.0-92.0). The probability of an SVR was 93.1% (95% CI 84.9-97.0) in those who obtained an RVR (6 studies, 82 patients) and 85.9% (95% CI 78.7-91.0) if an EVR (7 studies, 168 patients) was reached. Conclusion: Peginterferon with ribavirin is an effective option for treating acute HCV in HIV-positive patients, especially if they achieve an RVR or an EVR.

The hepatitis C cascade of care in the Belgian HIV population: One step closer to elimination

“…In our PLHIV population, the majority were infected with genotype 1a, followed by genotype 4 (a/c/d). This is similar to what was reported in international literature (Zhang et al, 2015). On the other hand, the majority of the PWID in the Belgian population was also infected with genotype 1a but followed by genotype 3 (Robaeys et al, 2016).…”

HCV micro-elimination in individuals with HIV in the Netherlands 4 years after universal access to direct-acting antivirals: a retrospective cohort study

“…20 Higher sustained virological response rates for patients with HCV infection were reported in the period shortly before any DAA were available when compared with results from clinical trials investigating the use of pegylated-interferon, 2 possibly because of earlier initiation of pegylated-interferon treatment. 21 There were also several studies actively recruiting MSM with HIV and early HCV infection (DAHHS1, 22 DAHHS2, 23 and REACT [NCT02625909]). However, the only large decrease in HCV infection incidence was observed in the DAHHS2 study, 23 and a modelling study has shown that no difference in HCV incidence would be observed with immediate initiation of DAA therapy compared with initiation of DAA therapy at 6 months.…”

Acute hepatitis C virus infection: clinical update and remaining challenges

“…The SVR24 rates of pegylated IFN (PEG-INF) with or without ribavirin (RBV) for 8 to 24 weeks in acute HCV infection range from 60% to 93%. [84][85][86][87][88][89][90] Although the antiviral response rates are fair with IFN-based therapies in patients with acute HCV infection, IFN is obsolete after the introduction of DAAs owing to the concerns about treatment-emergent adverse events (AEs) and the longer treatment duration.…”