Viral kinetics and early prediction of nonresponse to peg-IFN-alpha-2b plus ribavirin in HCV genotypes 1/4 according to HIV serostatus* (original) (raw)

2006, Journal of Viral Hepatitis

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-a-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 (5AE75 vs 5AE72 log 10 IU/ml, P ¼ 0AE6), HCV monoinfection led to significantly lower HCV-RNA values at weeks 4 (3AE7 vs 4AE3 log 10 IU/ml, P ¼ 0AE01), 12 (2AE3 vs 3AE5 log 10 IU/ml, P ¼ 0AE01) and 24 (1AE4 vs 3AE3 log 10 IU/ml, P ¼ 0AE001) and a higher rates of viral clearance at weeks 24 (60% vs 36%, P ¼ 0AE02), 48 (46% vs 25%, P ¼ 0.03) and 72 (37% vs 17%). The lack of achieving an HCV-RNA decrease of at least 1 log 10 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, 0AE86 [95% confidence interval (CI) 0AE77-0AE95], but not for HCV/ HIV-coinfected patients (cut-off, 0 log 10 , Se 100%, Sp 27%, PPV 21%, NPV 100%, ROC curve area, 0AE71 (95% CI 0AE49-0AE93). HIV coinfection was independently associated with failure (odds ratio 2.95, 95% CI 1AE08-8.04, P ¼ 0AE01). 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.