Strategies for assignment of HIV/HCV genotype 1-coinfected patients to either dual-therapy or direct-acting antiviral agent based triple therapy

Antivir Ther. 2013 Dec 17. doi: 10.3851/IMP2717. [Epub ahead of print]

Mandorfer M, Neukam K, Rivero A, Puoti M, Boesecke C, Baumgarten A, Grzeszczuk A, Zangerle R, Ernst D, Rockstroh JK, Trauner M, Pineda JA, Peck-Radosavljevic M, Reiberger T.

Abstract

BACKGROUND: The aim of this study was to evaluate strategies for assignment of HIV/hepatitis C virus genotype 1-coinfected patients (HIV/HCV-GT1) to either dual-therapy or direct-acting antiviral agent (DAA)-based triple-therapy.

METHODS: 148 treatment-naïve HIV/HCV-GT1 who received antiviral therapy with pegylated interferon/ribavirin were included in this multinational, retrospective analysis. Patients with rapid virologic response (RVR) were treated for 48weeks, while patients without RVR received either 48 or 72weeks of treatment. IL28B rs12979860 (IL28B) non-C/C, advanced liver fibrosis and high HCV-RNA were considered as established risk factors for treatment failure.

RESULTS: A trend toward higher SVR rates in patients with IL28B C/C (65%(37/57)vs.51%;(40/79); p=0.097) was observed. Higher SVR rates were observed in patients without advanced liver fibrosis (61%(47/77)vs.42%(22/52); p=0.036) and low HCV-RNA (73%(35/48)vs. 49%(49/100); p=0.006), as well as in patients with RVR (90%(35/39)vs.45%(49/109); p<0.001). SVR rates varied statistically significantly between the risk factors for treatment failure subgroups (0:86%(6/7)vs.1:69%(34/49)vs.2:48%(21/44)vs.3:(4/20); p<0.001). In patients without RVR, higher rates of SVR were observed in those treated for 72weeks (62%(23/37)), when compared to patients treated for 48weeks (36%(26/72); p=0.01).

CONCLUSIONS: RVR had an excellent PPV for the response to dual-therapy in HIV/HCV-GT1, emphasizing the utility of a lead-in phase for assigning these patients to dual-therapy or DAA-based triple-therapy. The use of an IL28B-guided approach was suboptimal, while a combination of established baseline predictors may provide guidance for individual treatment decisions prior to the initiation of antiviral therapy. However, the extension of treatment duration to W72 in HIV/HCV-GT1 without RVR should be strongly considered if triple-therapy is not available.

PMID: 24342953 [PubMed - as supplied by publisher]

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