Choice of nucleoside inhibitors in antiretroviral therapy regimens for HIV-infected patients treated for chronic hepatitis C

Abstract

The rates of development of virologic and biochemical responses and the incidence and degree of hematological disorders within the first 12 weeks of treatment for chronic hepatitis C (CHC) were determined in patients with HIV infection depending on the used agents from a group of nucleotide reverse transcriptase inhibitors as part of an antiretroviral therapy (ART) regimen. Seventy-eight patients with HIV infection and CHC who received ARVT for at least 3 months were followed up. According to the ARVT regimen, the patients were divided into 2 groups: 1) 46 took phosphaside incorporated into an ARVT regimen; 2) 32 received stavudine or abacavir. Among all the patients, rapid and complete early virologic responses (rEVR and cEVR) were obtained in 52 and 79% of cases, respectively. When phosphaside was used in the ART regimens, the rates of rEVR and cEVR development were significantly higher (95.8 and 53.3% of cases, respectively). The phosphaside-treated patients with hepatitis C virus (HCV) genotype 1 also had a high cEVR rate. The absolute majority of patients with HCV genotype 3 showed cEVR irrespective of the ART regimen. Following 12-week treatment for CHC, 83.3-95.5% had a reduction in alanine aminotransferase levels to the values observed in healthy individuals, which was also indicative of the efficiency of treatment. In the HIV infected patients treated for CHC, the use of phosphaside, stavudine, or abacavir was safe in terms of hematological complications. In the patients receiving phosphaside, the reduction in hemoglobin levels was more considerable. Evolving hematological disorders required no changes in the ART regimen or reductions in the dose of pegylated interferon or ribavirin.