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Successful treatment of acute hepatitis C virus in HIV positive patients using the European AIDS Treatment Network guidelines for treatment duration

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Abstract

Background

The incidence of acute hepatitis C virus (HCV) in HIV-positive patients is rising. Recent studies summarized by the European AIDS Treatment Network (NEAT)1 show that pegylated interferon alpha (PEG-IFNα) and ribavirin can lead to a sustained virological response (SVR) in approximately 60–80% of patients. Controversy remains on when to start treatment and whether 24 or 48 weeks of treatment lead to better outcomes.

Objectives

To assess the effectiveness of a treatment strategy for acute HCV infection in HIV-positive patients, in which patients with undetectable HCV RNA at 4 weeks (rapid virological response, RVR) receive 24 weeks, while those without receive 48 weeks of PEG-IFNα and ribavirin, as per the NEAT guidelines.

Study design

A retrospective cohort study of HIV-positive patients diagnosed with acute HCV infection between December 2006 and May 2010. Those who received acute treatment with PEG-IFNα and ribavirin had HCV RNA levels monitored and outcomes evaluated. For patients who did not receive acute treatment, the reason for deferral and most recent available HCV RNA were recorded.

Results

Twenty-two patients received acute treatment with PEG-IFNα and ribavirin. Twelve patients achieved RVR and had 24 weeks treatment, 10 patients had no RVR and had 48 weeks treatment. Two patients discontinued treatment (due to adverse effects [AEs] and failure to suppress HCV RNA sufficiently at 12 weeks). All 20 patients who completed treatment had SVR.

Conclusion

Our high SVR rate of 91% supports the new NEAT treatment duration recommendations.

Section snippets

Background

There is a rising incidence of hepatitis C virus (HCV) in HIV-positive patients in Europe, North America and Australia,2 fuelled by sexual transmission between men who have sex with men (MSM).3, 4 The epidemic is centred around urban areas with large MSM populations, and has been especially well documented in London, United Kingdom.5, 6 Given the high morbidity from chronic HCV infection, development of effective treatment strategies to clear acute HCV infection is crucial. In the absence of

Objectives

To assess the effectiveness of a treatment strategy for acute hepatitis C in HIV-positive patients, in which patients receive 48 weeks of PEG-IFNα and ribavirin unless they achieve RVR, in which case they receive 24 weeks of treatment, as per the NEAT guidelines.

Study design

This is a retrospective cohort study of HIV-positive patients with acute HCV infection diagnosed between December 2006 and May 2010. Patients with a positive HCV RNA or antibody test and a negative test within the last 6 months, or with a newly raised alanine transaminase (ALT) in the past 6 months were included in the analysis.

Clinical data including demographics, comorbidities and potential routes of transmission were collected. Patients were assessed medically for suitability for acute

Results

Thirty-four HIV-positive patients with acute hepatitis C infection were identified during the study period, all of which were MSM. Men were mainly from White European backgrounds (85%) and mean age was 41 years (range 25–63). The majority of patients (88%) were infected with HCV genotype 1, 6% with type 3 and 6% with type 4 (Table 1).

Twenty-two (65%) of these patients received acute treatment with PEG-IFNα and ribavirin. Mean time from diagnosis to treatment was 14.3 weeks (range 4.4–26.0).

Discussion

This is the first published study that uses the treatment duration recommendations of the new NEAT Guidelines1 for treatment of acute HCV in HIV-positive patients. Previously in this centre, all HIV-positive patients with acute HCV were given 48 weeks of PEG-IFNα and ribavirin in order to maximise treatment success rates. When it became clear that RVR was a strong predictor of SVR, it was decided that these patients could safely be offered 24 weeks treatment alone, and we have persisted with

Funding

None.

Competing interests

None declared.

Ethical approval

Not required.

Acknowledgements

None.

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