Rapid and early virological response to chronic Hepatitis C treatment with IFN 2b or PEG-IFN & [alpha]2b plus ribavirin in HIV/HCV co-infected patients

Christopher Payan ¹, Adeline Pivert ¹, Patrice Morand ², Samira Fafi-Kremer ², Fabrice Carrat ³, Stanislas Pol ⁴, Patrice Cacoub ⁵, Christian Perronne ⁶ and Françoise Lunel ^1*

¹ Laboratoire de Bactériologie-Virologie-Hygiéne Hospitalière, CHU Angers, France
² Laboratoire de Virologie, CHU Grenoble, France
³ Inserm U707, Facultè de Mèdecine St Antoine, Paris, France
⁴ Service d' Hèpatologie, Hopital Necker-Enfants Malades, Paris, France
⁵ Service de Mèdecine Interne, Hopital Pitiè-Salpètrière, Paris, France
⁶ Service des Maladies Infectieuses et Tropicales, Hopital Raymond Poincarè, Paris, France

^* To whom correspondence should be addressed. E-mail: frlunel-fabiani{at}chu-angers.fr.

Accepted 2 March 2007

Abstract

Background and aim: An algorithm based on a 2 log10 decline of HCV RNA at week (W) 12 has been proposed in US and European recommendations for the management of patients with chronic hepatitis C treated with pegylated- interferon and ribavirin.

Methods: We have studied rapid virological response (RVR, i.e. at W2 and W4 after the initiation of therapy) in HIV/HCV co-infected patients. Using HCV RNA measurements (Versant® HCV RNA 3.0, Cobas Amplicor HCV 2.0), RVR was studied in 323 patients from the ANRS HC02 RIBAVIC trial, comparing Interferon 2b 3 MU x3/week versus Pegylated Interferon 2b 1.5 µg/kg/week, each combined with ribavirin 800 mg/day during 48 weeks.

Results: The best positive and negative predictive values of sustained virological response (SVR) were respectively obtained with an undetectable HCV RNA at W4 (97%) and with more than a 2 log10 decrease at W12 (99%). Prediction of non-SVR was obtained in all patients by using HCV RNA cutoff levels above 460,000 IU/ml at W4 and above 39,000 UI/ml at W12 whatever the HCV genotype and arm of treatment.

Conclusion: We propose a new algorithm based on RVR thresholds using HCV RNA that allows for excellent prediction of non-SVR as early as W4.

Keywords: HCV viral load, HIV/HCV coinfection, hepatitis C therapy, prediction of response, rapid and early viral decline

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