HCV Viral Decline at Week 2 of Peg-IFN-Alpha-2a/RBV Therapy as a Predictive Tool for Tailoring Treatment in HIV/HCV Genotype 1 Co-Infected Patients.

PloS one

PubMedID: 24945348

Rivero-Juarez A, López-Cortés LF, Camacho A, Torres-Cornejo A, Gordon A, Ruiz-Valderas R, Torre-Cisneros J, Pineda JA, Viciana P, Rivero A. HCV Viral Decline at Week 2 of Peg-IFN-Alpha-2a/RBV Therapy as a Predictive Tool for Tailoring Treatment in HIV/HCV Genotype 1 Co-Infected Patients. PLoS ONE. 2014;9(6):e99468.
BACKGROUND
Optimizing HCV genotype 1 therapy in terms of response prediction and tailoring treatment is undoubtedly the cornerstone of treating HIV co-infected patients in clinical practice. Accordingly, our aim was to analyze the predictive value of HCV viral decline for sustained virological response (SVR), measured at a time point as early as week 2 of therapy with pegylated interferon alpha-2a plus ribavirin (Peg-IFN/RBV).

METHODS
Previously untreated HIV/HCV genotype 1 co-infected patients were included in this study. The HCV RNA titer was measured at week 2 after starting treatment with Peg-IFN/RBV. The likelihood of reaching SVR when HCV RNA viral titers declined at week 2 was evaluated relative to predictive baseline factors.

RESULTS
A total of 192 HIV/HCV genotype-1 co-infected patients were enrolled in the study and began therapy. One hundred and sixty-three patients completed a full course of Peg-IFN/RBV treatment for 2 weeks and 59 of these (36.2%) reached SVR. An HCV RNA viral load decline of =1.5 log IU/mL at week 2 had the maximum positive predictive value for SVR (83.3%; 95% CI: 68.5%-92.9%) and was identified as the strongest independent predictive factor for reaching SVR across all baseline predictive factors.

CONCLUSIONS
HCV viral decline at week 2 had a high predictive value for identifying patients with a high and low likelihood of reaching SVR using dual therapy, regardless of strong predictive baseline factors. This finding may be useful for developing a predictive tool to help tailor HCV genotype 1 therapy in HIV co-infected patients.