Viral kinetics and early prediction of nonresponse to peg-IFN-α-2b plus ribavirin in HCV genotypes 1/4 according to HIV serostatus

• Published in: Journal of viral hepatitis Vol. 13; no. 7; pp. 466 - 473
• Main Authors: Moreno, A., Bárcena, R., García-Garzón, S., Moreno, L., Quereda, C., Muriel, A., Zamora, J., Mateos, M. L., Pérez-Elías, M. J., Antela, A., Diz, S., Moreno, S.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2006
• Subjects: cut-off; HCV-RNA kinetics; human immunodeficiency virus; pegylated interferon/ribavirin
• ISSN: 1352-0504; 1365-2893
• DOI: 10.1111/j.1365-2893.2005.00710.x

To evaluate, among 70 hepatitis C virus (HCV)‐monoinfected and 36 human immunodeficiency virus (HIV)‐coinfected naïve patients with genotypes 1/4 receiving weight‐adjusted pegylated interferon‐α‐2b/ribavirin, viral kinetics and the feasibility to predict treatment failure measuring early HCV‐RNA decreases. HCV‐RNA was assessed at baseline, weeks 4, 12 and 24. Receiver operating characteristic (ROC) curves were calculated to determine the most sensitive cut‐off values of viral decrease at week 4 predicting treatment failure. Baseline predictors of failure were evaluated by univariate and multivariate analyses. Despite similar baseline HCV‐RNA (5·75 vs 5·72 log10IU/ml, P = 0·6), HCV monoinfection led to significantly lower HCV‐RNA values at weeks 4 (3·7 vs 4·3 log10IU/ml, P = 0·01), 12 (2·3 vs 3·5 log10IU/ml, P = 0·01) and 24 (1·4 vs 3·3 log10IU/ml, P = 0·001) and a higher rates of viral clearance at weeks 24 (60%vs 36%, P = 0·02), 48 (46%vs 25%, P = 0.03) and 72 (37%vs 17%). The lack of achieving an HCV‐RNA decrease of at least 1 log10 at week 4 was highly predictive of treatment failure for HCV‐monoinfected patients (Se 100%, Sp 50%, positive predictive value (PPV) 57%, negative predictive value (NPV) 100%, ROC curve area, 0·86 [95% confidence interval (CI) 0·77–0·95], but not for HCV/HIV‐coinfected patients (cut‐off, 0 log10, Se 100%, Sp 27%, PPV 21%, NPV 100%, ROC curve area, 0·71 (95% CI 0·49–0·93). HIV coinfection was independently associated with failure (odds ratio 2.95, 95% CI 1·08–8.04, P = 0·01). Thus the magnitude of HCV‐RNA decreases at week 4 correlated with treatment response. Significant differences in viral kinetics and cut‐off values predicting nonresponse suggest a slower HCV clearance rate in HIV coinfection, which was independently associated with treatment failure.