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 α2b 3 MU x3/week versus Pegylated Interferon α2b 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.
- HCV viral load
- HIV/HCV coinfection
- hepatitis C therapy
- prediction of response
- rapid and early viral decline