Abstract
Objective: To determine the influence of nevirapine (NVP) and lopinavir/ritonavir (LPV/r) on the efficacy of pegylated interferon (peg-IFN) plus ribavirin (RBV) among HIV/HCV-coinfected patients. Methods: All HIV/HCV-coinfected patients who received peg-IFN plus RBV while under a three-drug antiretroviral regimen including tenofovir (TDF) plus lamivudine (3TC) or emtricitabine (FTC) along with NVP or along with LPV/r at twenty hospitals in Spain were included in this retrospective study. Sustained virological response (SVR) rates in both groups were compared. Results: A total of 165 patients were included in the study, 71 (43%) receiving NVP and 94 (57%) LPV/r. Significantly more patients on LPV/r had a baseline HCV-RNA load ≥600000 IU/mL (44% vs. 73%, p=0.001). Forty (56%) individuals included in the NVP group and 35 (37%) in the LPV/r group showed SVR (p=0.015). In the NVP group, 19 (43%) patients carrying genotype 1-4 and 21 (78%) subjects with genotype 2-3 achieved SVR. In the LPV/r group, the corresponding figures were 25% (p=0.04) and 59% (p=0.1). In the subpopulation of individuals with baseline HCV viral load ≥600,000 IU/mL, 18 (58%) of those taking NVP vs. 21 (31%) who were given LPV/r reached SVR (p=0.01). HCV genotype 2-3, adherence to HCV therapy >80% and use of NVP during peg-IFN plus RBV were independently associated with SVR in the multivariate analysis. Conclusions: HIV/HCV-coinfected patients who receive NVP respond better to peg-IFN plus RBV than those individuals receiving LPV/r. Lower HCV viral load due to NVP treatment may account for the former differences.
Highlights
Concomitant antiretroviral therapy (ART) can be a factor leading to a lower efficacy of pegylated interferon plus ribavirin (RBV) in human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients [1,2,3,4,5,6,7,8]
All individuals seen from January 2002 through January 2009 in twenty hospitals from Spain, who fulfilled the following criteria, were included for this retrospective study: 1) Older than 18 years; 2) Diagnosed with HIV infection and chronic hepatitis C; 3) Started a first course of therapy against HCV infection with pegylated interferon (peg-IFN) plus RBV treatment, and, 4) Were receiving a three-drug antiretroviral regimen containing TDF plus 3TC or FTC along with NVP or LPV/r when they began therapy against HCV infection
We assessed the relationship between Sustained virological response (SVR) rate and the following variables: age, sex, body mass index, risk factor for HCV transmission, HCV genotype, baseline plasma HCV-RNA load, baseline plasma level of alanine aminotransferase and low-density lipoprotein cholesterol, CDC clinical category, CD4+ cell count and HIV-RNA at baseline, liver fibrosis stage according to the Scheuer’s scoring system [12] in patients who had had a pretreatment liver biopsy, type of peg-IFN given, daily dose of RBV by weight, participating center, calendar year of beginning anti-HCV therapy, self-reported compliance with therapy, time with undetectable HIV viral load before starting HCV therapy and time from starting NVP or LPV/r to beginning therapy against HCV infection
Summary
Concomitant antiretroviral therapy (ART) can be a factor leading to a lower efficacy of pegylated interferon (peg-IFN) plus ribavirin (RBV) in human immunodeficiency virus (HIV)/hepatitis C virus (HCV)-coinfected patients [1,2,3,4,5,6,7,8]. The use of abacavir has been associated in some reports with a lower efficacy of therapy against HCV infection than combinations containing tenofovir (TDF) [7,8]. TDF plus lamivudine (3TC) or emtricitabine (FTC) is the first choice of NRTI combinations in coinfected individuals on treatment for HCV infection [1,7]
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