HIV-HCV Coinfected Patients Are More Likely to Experience HCV Relapse after Completing Treatment, Usually within 12 Weeks

		SUMMARY: HIV-HCV coinfected patients were less likely than HCV monoinfected individuals to clear HCV by the end of interferon-based therapy and more apt to relapse after completing treament, and therefore were less likely to achieve a sustained virological response (SVR), according to a Spanish study published in the November 1, 2009 issue of Clinical Infectious Diseases.

By Liz Highleyman

Considerable research has shown that HIV-HCV coinfected people tend to experience faster liver disease progression and respond less well to interferon-based therapy that patients with HCV alone, but there is little data on the rate and timing of hepatitis C virus (HCV) relapse after completing treatment.

In the present retrospective study, researchers at Hospital Carlos III in Madrid, Spain looked at medical record from 604 chronic hepatitis C patients -- 386 of whom were also HIV positive -- treated with pegylated interferon plus ribavirin between 2001 and 2007.

Results

	HIV-HCV coinfected patients achieved an end-of-treatment response less often than HCV monoinfected patients (37% vs 61%, respectively).
	Coinfected patients were also more likely than monoinfected patients to experience relapse following treatment (33% vs 22%, respectively).
	Relapse occurred more often in patients with hard-to-treat HCV genotypes 1 or 4, compared with genotypes 2 or 3.
	In both HIV positive and HIV negative participants, HCV relapse, when it occurred, usually happened before week 12 post-treatment.
	3 patients tested HCV positive after post-treatment week 12, but genetic analysis indicated that 2 of these cases likely were due to re-infection rather than relapse.

Because coinfected individuals were both less likely to respond by the end of treatment and more likely to relapse, they had a lower likelihood of SVR -- or a cure -- defined as continued undetectable HCV viral load 24 weeks after completion of therapy, the researchers concluded.

Department of Infectious Diseases, Service of Hepatology and CIBERehd, and Service of Pharmacy, Hospital Carlos III, Madrid, Spain; Laboratory of Molecular Epidemiology of Infectious Diseases, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain.

10/30/09

Reference
J Medrano, P Barreiro, S Resino, and others. Rate and timing of hepatitis C virus relapse after a successful course of pegylated interferon plus ribavirin in HIV-infected and HIV-uninfected patients. Clinical Infectious Diseases 49(9): 1397-1401. November 1, 2009. (Abstract).