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Erschienen in: Wiener klinische Wochenschrift 11-12/2016

01.06.2016 | original article

Treatment intensification with boceprevir in HIV-positive patients with acute HCV-genotype 1 infection at high risk for treatment failure

verfasst von: Mattias Mandorfer, MD, Sebastian Steiner, Philipp Schwabl, MD, Berit A. Payer, MD, Maximilian C. Aichelburg, MD, Katharina Grabmeier-Pfistershammer, MD, Michael Trauner, MD, Thomas Reiberger, MD, Markus Peck-Radosavljevic, MD

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 11-12/2016

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Summary

Background

According to current guidelines, the universal use of direct-acting antiviral agents in HIV-positive patients with acute hepatitis C (AHC) is not recommended. We aimed to evaluate the concept of treatment intensification with boceprevir (BOC) in HIV-positive patients with HCV-genotype 1 AHC (HIV/AHC-GT1) at high risk for failure to pegylated interferon/ribavirin therapy (PEGIFN/RBV).

Methods

Nineteen consecutive HIV-positive patients with HIV/AHC-GT1 who underwent antiviral therapy were studied retrospectively.
Patients were treated with PEGIFN/RBV for 24 or 48 weeks, depending on rapid virologic response (RVR; undetectable HCV-RNA at treatment week [W] 4). Patients without complete early virologic response (cEVR; undetectable HCV-RNA at W 12) were offered treatment intensification with BOC at W 12, resulting in 36 weeks of BOC/PEGIFN/RBV triple therapy (total treatment duration: 48 weeks).

Results

Thirty-seven percent (7/19) of patients had an RVR and 74 % (14/19) of patients had a cEVR. BOC was used in four out of five patients who did not achieve cEVR and one patient elected to proceed with PEGIFN/RBV.
Sustained virologic response (SVR; undetectable HCV-RNA 24 weeks after the end of treatment) rates were 100 % (14/14) among patients with cEVR treated with PEGIFN/RBV and 75 % (3/4) among patients without cEVR receiving BOC add-on. The patient without cEVR who preferred to continue with PEGIFN/RBV did not achieve SVR. Thus, the overall SVR rate was 89 % (17/19) in intention to treat analysis.

Conclusions

BOC add-on in selected HIV/AHC-GT1 resulted in a high overall SVR rate. If 2nd generation direct-acting antiviral agents (DAAs) are not available, treatment intensification with BOC can be considered in HIV/AHC-GT1 at high risk for failure to PEGIFN/RBV.
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Metadaten
Titel
Treatment intensification with boceprevir in HIV-positive patients with acute HCV-genotype 1 infection at high risk for treatment failure
verfasst von
Mattias Mandorfer, MD
Sebastian Steiner
Philipp Schwabl, MD
Berit A. Payer, MD
Maximilian C. Aichelburg, MD
Katharina Grabmeier-Pfistershammer, MD
Michael Trauner, MD
Thomas Reiberger, MD
Markus Peck-Radosavljevic, MD
Publikationsdatum
01.06.2016
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 11-12/2016
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-015-0912-6

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