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Rapid and early virological response to chronic hepatitis C treatment with IFN α2b or PEG-IFN α2b plus ribavirin in HIV/HCV co-infected patients


Background and aims: An algorithm based on a 2 log10 decline in hepatitis C virus (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 examined rapid virological response (RVR; 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 ×3/week with pegylated interferon α2b 1.5 μg/kg/week, each combined with ribavirin 800 mg/day over 48 weeks.

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

  • EVR, early virological response
  • HAART, highly active antiretroviral treatment
  • HCV, hepatitis C virus
  • IFN, interferon
  • NPV, negative predictive value
  • NR, non-responders
  • PEG-IFN, pegylated interferon
  • PPV, positive predictive value
  • RB, responders with breakthrough
  • ROC, receiver operating characteristics
  • RR, responders with relapse
  • RVR, rapid virological response
  • SVR, sustained virological response/responders
  • HIV/HCV co-infection
  • hepatitis C therapy
  • HCV viral load
  • rapid and early viral decline
  • prediction of response

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