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Rates and predictors of response to anti-viral treatment for hepatitis C virus in HIV/HCV co-infection

The most recent issue of the Alimentary Pharmacology & Therapeutics investigates rates and predictors of response to anti-viral treatment for hepatitis C virus in HIV/HCV co-infection in a nationwide study.

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The effectiveness of anti-viral treatment for hepatitis C virus (HCV) in HIV/HCV co-infected patients in ‘real world’, clinical practice is unclear.

Dr Ioannou and colleagues from Washington, USA determined the rates and predictors of sustained virological response (SVR) to anti-viral treatment for HCV with pegylated interferon (PEG-IFN) and ribavirin in HIV/HCV co-infected patients.

The researchers identified all HIV/HCV co-infected patients who received anti-viral treatment with PEG-IFN, and ribavirin in the Veterans Affairs healthcare system nationally between 2002 and 2009.

The team found that sustained virological response was achieved in 22% overall, 17% among patients with genotype 1 HCV, and 44% among patients with genotype 2 or 3 HCV.

Sustained virological response was achieved in 22% overall
Diseases of the Colon & Rectum

Among genotype 1-infected patients, characteristics that were negatively associated with sustained virological response independently included baseline HCV viral load more than 2 million IU/mL, Black race, diabetes, baseline anemia, serum aspartate aminotransferase/alanine aminotransferase ratio 1.2 or more, and use of zidovudine.

The team found that characteristics positively associated with sustained virological response included a starting dose of ribavirin 1000–1200 mg/day or more, and erythropoietin use during treatment.

Among genotype 2 or 3 infected patients, only erythropoietin use was an independent predictor of sustained virological response, while a starting dose of ribavirin more than 800 mg/day was not associated with sustained virological response.

Dr Ioannou's team concludes, "Sustained virological response rates achieved with PEG-IFN and ribavirin in HIV/HCV co-infected patients are low in clinical practice."

"The use of erythropoietin was the most important, modifiable factor associated with sustained virological response."

Aliment Pharmacol Ther 2013: 38(11-12): 1373–1384
20 November 2013

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