AEGiS-15IAC: Clinical effectiveness of HCV treatment in HIV/HCV co-infected patients and the utility of liver biopsy in real practice.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Clinical effectiveness of HCV treatment in HIV/HCV co-infected patients and the utility of liver biopsy in real practice.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. B10397)

Chihrin S, Loutfy MR, Raboud J, Saskin R, Govan V, Dimayuga R, Rachlis A, Kovacs C, Crouzat F, Tilley D, Chang B, Phillips E, Walmsley S, Fletcher D
Canadian Immunodeficiency Research Collaborative, Toronto, Ontario, Canada

BACKGROUND: To determine the utilization of liver biopsy and effectiveness of interferon (IFN) (regular and pegylated) plus ribavirin (RBV) in HIV/HCV co-infected patients.

METHODS: A retrospective chart review was completed for 151 HIV/HCV co-infected patients from 2 Toronto centres. Reasons for and treatment decisions based on liver biopsy were assessed. Of the 151 patients, 17 were treated with regular-IFN/RBV and 8 with peg-IFN/RBV. The HCV RNA response, ALT change and the completion rate of HCV treatment were assessed.

RESULTS: Of 35 patients with liver biopsies (23%), 26 (74%) had grade 2-4 disease and 12 were treated for HCV. The median baseline ALT at biopsy was 59 (IQR 36, 143) compared to a median of median ALTs of 54 (IQR 34, 83) among patients that did not have a biopsy. Of the 25 patients treated, 56% had serotype 1. The 17 treated with regular-IFN/RBV had a median treatment period of 27 weeks (IQR 23, 29) and one patient completed the full 48-weeks. The median fall from the baseline to first follow-up ALT was 75 U/L (IQR 7, 220) (p=0.004). The 8 patients treated with peg-IFN/RBV had a median treatment period of 12 weeks (IQR 8, 13); 6 discontinued therapy before the full 48 week course and 2 are in progress. In four patients, the median fall from the baseline to first follow-up HCV RNA was 0.3 log₁₀ copies/mL (IQR -0.2, 2.1) (p=0.50). The median fall from the baseline to first follow-up ALT was 95 (IQR 45, 166) (p=0.03).

CONCLUSIONS: Although guidelines recommend liver biopsies for staging in patients with detectable HCV RNA, they are not commonly done and are done in more advanced patients. Of the 8 patients started on peg-INF/RBV, 6 terminated therapy early. Treatment with peg-INF/RBV may prove to be less optimal in real clinical setting than expected.

Keywords: AEGIS, HIV, Hepacivirus, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Ribavirin, Interferon Alfa-2b, Interferons, HIV Infections, Alanine Transaminase, Drug Therapy, Combination, HIV-1, Biopsy, Antiretroviral Therapy, Highly Active, Humans, therapy, drug therapy

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B10397