Rapid virological response at week 4 predicts response to pegylated interferon plus ribavirin among HIV/HCV-coinfected patients

• Published in: Antiviral therapy Vol. 12; no. 4; pp. 523 - 529
• Main Authors: Mira, José A, Valera-Bestard, Bárbara, Arizcorreta-Yarza, Ana, González-Serrano, Mercedes, Torre-Cisneros, Julián, Santos, Ignacio, Vergara, Salvador, Gutiérrez-Valencia, Alicia, Girón-González, José A, Macías, Juan, López-Cortés, Luis F, Pineda, Juan A
• Format: Journal Article
• Language: English
• Published: London International Medical Press 01.01.2007
• Subjects: Adult; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiviral agents; Antiviral Agents - administration & dosage; Antiviral Agents - therapeutic use; Biological and medical sciences; Drug Therapy, Combination; Female; Hepacivirus - drug effects; Hepacivirus - physiology; Hepatitis C, Chronic - complications; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - virology; HIV Infections - complications; HIV Infections - drug therapy; HIV Infections - virology; HIV-1 - drug effects; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Interferon-alpha - administration & dosage; Interferon-alpha - therapeutic use; Male; Medical sciences; Pharmacology. Drug treatments; Polyethylene Glycols; Predictive Value of Tests; Recombinant Proteins; Ribavirin - administration & dosage; Ribavirin - therapeutic use; RNA, Viral - blood; Time Factors; Treatment Outcome; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Human; Immunopathology; Drug combination; Mixed infection; Cytokine; AIDS; Immune deficiency; Ribavirin; Infection; Virus; Viral disease; Nucleoside analog; Antiviral; Interferon; Flaviviridae; Predictive factor; Pegylated form; Hepatitis C virus; Hepacivirus
• ISSN: 1359-6535; 2040-2058
• DOI: 10.1177/135965350701200412

The clinical applicability of early viral kinetics at week 4 in predicting sustained virological response (SVR) of pegylated interferon (peg-IFN) plus ribavirin (RBV) in HIV/HCV-coinfected patients is unclear. Our objective was to determine if rapid virological response (RVR) at week 4 of therapy with peg-IFN and RBV could predict SVR among HIV/HCV-coinfected patients. HIV/HCV-coinfected patients in whom an HCV viral load determination had been carried out at week 4 of therapy were included in the study. The positive predictive value (PPV) and the negative predictive value (NPV) of RVR (undetectable serum HCV RNA at 4 week) for SVR were calculated in the study population. Receiver operating characteristic curves were calculated to determine the best cutoff of HCV RNA decrease to predict treatment failure. A total of 101 HIV/HCV-coinfected patients were included. RVR and SVR were observed in 39 (39%) and in 49 (48%) individuals, respectively. Of patients with RVR, 37/39 patients achieved SVR (PPV: 95%), whereas 50/62 individuals without RVR did not show SVR (NPV: 81%). The highest NPV (96%) was reached by using a cutoff level of HCV RNA decrease of 0.6 log10. By applying this cutoff level, treatment could have been discontinued in 25 (25%) patients. An undetectable serum HCV RNA determination at week 4 of treatment with peg-IFN plus RBV is a reliable predictor of SVR in HIV/HCV-coinfected patients. In addition, a decrease of HCV RNA less than 0.6 log10 at this point of treatment could identify an appreciable proportion of individuals who will fail to achieve SVR.