Patients who have an undetectable hepatitis C viral load within four weeks of the initiation of hepatitis C therapy are likely to be successfully treated for hepatitis C infection, according to a German study presented to the Fourth International Workshop on HIV and Hepatitis Coinfection in Madrid on June 20th. The investigators also found that stable HIV infection without a need for anti-HIV therapy predicted an undetectable hepatitis C viral load twelve weeks after starting anti-hepatitis C treatment.
Investigators in the western German cities of Bonn and Cologne wanted to determine the factors associated with successful hepatitis C therapy in HIV/hepatitis C-coinfected patients.
They therefore designed a retrospective study involving 227 individuals who received anti-hepatitis C therapy that included pegylated interferon and ribavirin.
Most of the patients were male (73%), the mean age was 41 years, and 59% of individuals were taking anti-HIV treatment. Average CD4 cell count at the initiation of anti-hepatitis C treatment was 531 cells/mm3, with average HIV viral load being a little over 11,000 copies/ml, reflecting the fact that over 40% of patients were not on antiretroviral therapy.
The most common hepatitis C genotype was the hard to treat genotype 1 (56%), with a further 7% of patients having infection with genotype 4, which is also associated with a poor response to anti-hepatitis C treatment.
Overall, 41% of patients achieved a sustained virological response. The investigators then looked at which factors predicted this outcome.
The first of the factors they identified was, as expected, infection with the easier to treat hepatitis C genotypes 2 and 3 (p
When the investigators looked at factors associated with an early virological response, they found that these once again included infection with genotypes 2 and 3 (p
The investigators were surprised by this final finding. But they said that patients with high CD4 cell counts, and therefore no need to take anti-HIV treatment, were therefore able to avoid the possible liver-toxic interactions between antiretroviral and anti-hepatitis C drugs, increasing the chances of their livers clearing hepatitis C infection.
Janke M. et al. Which factors predict early and sustained virological response under combination hepatitis C therapy in HIV/HCV co-infected patients? Fourth International Workshop on HIV and Hepatitis Coinfection, Madrid, abstract 14, 2008.