Early treatment of hepatitis C effective in HIV-positive patients

Treatment of hepatitis C infection during the early phase of infection can achieve similar response rates to treatment of chronic infection in patients co-infected with HIV, according to two pilot studies presented last week at the Tenth European AIDS Conference / European AIDS Clinical Society in Dublin.

Liver diseases including hepatitis C are an important cause of disease in HIV-positive patients. Although the treatment of chronic hepatitis C infection in HIV-positive patients has been assessed in a number of large prospective clinical trials, the treatment of hepatitis C in the first few months after infection has received limited attention.

Two small studies presented in Dublin assessed the impact of hepatitis C treatment with peginterferon alfa-2a (Pegasys) with or without ribavirin (Copegus / Rebetol) during acute infection. Both studies found high rates of clearance of the hepatitis C virus.

The first study recruited 25 gay men with evidence of acute hepatitis C infection following raised liver enzymes or symptoms of hepatitis C infection, confirmed by detection of hepatitis C virus in the blood. All but one of the patients was taking antiretroviral therapy.

Nineteen of the men were treated for 24 weeks with 180µg peginterferon alfa-2a once a week and 800mg ribavirin once a day. One patient cleared hepatitis C before starting treatment and five refused treatment. The median time from infection to the start of treatment was 14 weeks.

At 24 weeks after the end of treatment, ten (71%) of the 14 patients who had reached this time point had no detectable hepatitis C virus in the blood. Of the four patients who failed to achieve this, one was lost to follow-up, two had virological failure and one had become re-infected after clearing the virus.

Hepatitis C virus treatment was well tolerated with no dose adjustments required because of side-effects. There was also no effect of treatment on CD4 cell counts or HIV viral load.

The second study followed a similar course to the first, recruiting 31 men with known or suspected exposure to hepatitis C virus, detection of hepatitis C antibodies or increased liver enzymes.

At the end of 24 weeks of treatment with peginterferon alfa-2a either alone or with ribavirin, 19 (61%) of the patients had no detectable hepatitis C virus in the blood. Although this study did not report the ‘sustained virological response’ at 24 weeks after the end of treatment, it also suggests that early treatment may be beneficial for HIV-positive patients who are infected with the hepatitis C virus.

The investigators did not find any differences in response rates between genotypes of hepatitis C virus or between patients treated with and without the addition of ribavirin. However, the number of patients treated may be to small for these differences to be detected.

Despite this, the investigators found that successful clearance of the virus by weeks 4, 8 or 12 or treatment, as well as hepatitis C infection less than four months before the start of treatment were linked to a better response rate.

Jürgen Rockstroh, presenting, commented that the response rate observed in this study is similar to those seen in HIV-co-infected patients treated during after long-term infection with hepatitis C. Although larger prospective studies are required to confirm these findings, they suggest that the treatment of acute hepatitis C infection could become a useful strategy for co-infected patients in whom hepatitis C is detected soon after infection.