HIV-positive individuals with acute hepatitis C may be able
to clear the infection with just 24 weeks of therapy, Dutch research published
in the online edition of AIDS
suggests.
The retrospective study involved 50 HIV-positive gay men
with acute hepatitis C who received care at two hospitals in Amsterdam.
Patients at one hospital were provided with hepatitis C
therapy lasting 24 weeks, whereas individuals at the second hospital received
the standard 48 weeks of treatment.
There were no significant differences in rates of hepatitis
C clearance (a sustained virological response [SVR], or negative hepatitis C
viral load six months after the completion of therapy) between the two groups
of patients.
“This suggests that 24 weeks of treatment might be
sufficient,” comment the authors.
There is an ongoing epidemic of sexually transmitted
hepatitis C in HIV-positive gay men in northern Europe. Routine HIV care should
include regular monitoring of liver function as well as hepatitis C testing for
individuals who are at risk of the infection. This means that many hepatitis C
infections are diagnosed in the acute stage.
Earlier research has shown that treating acute hepatitis C
infection in HIV-positive patients can achieve high rates of cure.
Therapy normally consists of weekly pegylated interferon and
daily doses of weight-based ribavirin.
Side-effects are common and can be unpleasant. Therefore
investigators from Amsterdam wanted to see if the duration of therapy could be
shortened from the standard 48 weeks to just 24 weeks.
They therefore designed a retrospective study involving
HIV-positive gay men diagnosed with acute hepatitis C infection between 2003
and 2009.
Most (58%) of patients received 48 weeks of treatment,
whereas the remaining 42% received treatment lasting 24 weeks.
The impact of treatment on hepatitis C viral load after four
and twelve weeks is a major predictor of longer-term outcomes. Therefore the
investigators monitored treatment responses at these time points, as well as at
the end of therapy, and six months after its completion.
Treatment was stopped early by six patients (12%), either
because of a lack of response or side-effects.
At the end of treatment, 88% of patients had an undetectable
viral load. Six individuals subsequently relapsed, meaning that 76% of patients
still had undetectable viral load six months after the completion of therapy
and their hepatitis C infection was therefore cured.
“The sustained virological response rate…in this study
confirms that treatment of HCV infection can be successful in HIV-infected
patients when started in the acute phase, and should encourage clinicians to
treat this complicated patient group,” write the authors.
A treatment response at week four was associated with
significantly better rates of cure (p = 0.043).
Individuals who received 48 weeks of therapy had twice the
chance of being cured. However, this could have been down to chance, as the
difference in outcomes with patients who received the shorter treatment regimen
was not significant (adjusted odds ratio, 2.32; 95% CI, 0.39-13.97).
“The shorter regimen would be of great advantage for
patients, since both peginterferon and ribavirin can cause serious side-effects,”
suggest the researchers who acknowledge that their study was limited by its
small sample size.
Nevertheless, the authors conclude, “the results of this
retrospective cohort of HIV-infected MSM with acute HCV infection demonstrates
that acute HCV infection in this coinfected population can be very effective
and 24 weeks treatment may be sufficient.”