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RESPONSE TO PEGINTERFERON alpha-2B + RIBAVIRIN COMBINATION THERAPY IN HIV-HCV CO-INFECTED PATIENTS: RESULTS OF THE CANADIAN POWER PROGRAM
D Wong, J Robert, D Kilby, M Joffe, D Pearson, D Menard, R Woolstencroft, P Marotta
Toronto Western Hospital; Centre Sida Amitié des Laurentides; University of Ottawa; University of Alberta; Victoria, BC; Université de Sherbrooke; Schering-Plough Canada; London Health Sciences Centre
AIM: This sub-analysis of the Canadian Pegetron POWeR program examines SVR rates in patients who were co-infected with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) and received weight-based peginterferon (PEG-IFN) alpha-2b plus weight-based RBV.
METHODS: POWeR was an open-label, observational study conducted in academic and community clinics across Canada between 2002 and 2007. Treatment-naive patients received PEG-IFN alpha-2b (1.5 µg/kg/wk) plus weight-based RBV (800-1200mg/d) as described previously. SVR was defined as undetectable HCV RNA 24 weeks post-treatment. SVR rates were evaluated by genotype (G), baseline viral load and fibrosis.
RESULTS: 1977 patients initiated treatment, 27 of whom (1.4%) were co-infected with HIV and HCV. This analysis was based on 26 HIV/HCV co-infected patients who received at least one dose of medication and had treatment data, including those who discontinued because of side effects, lack of response, or personal reasons. The majority of patients were infected with G1 (21/26, 80.8%), followed by G2 (3/26, 11.5%) and G3 (2/26, 7.7%). Overall SVR was 9/26 (35%); G1 SVR was 6/21 (29%) and G2/G3 SVR was 3/5 (60%). Liver biopsy specimens were available for 12 patients, eight of whom (67%) had F3-F4 fibrosis (5 F4, 42%; 3 F3, 25%); SVR was attained by 2/8 (25%) patients with F3-F4 fibrosis. Baseline viral load was available in 24 patients; SVR was achieved by 4/6 (67%) patients with low viral load (<600,000 IU/mL) versus 4/18 patients (22%) with high viral load (=>600,000 IU/mL). Discontinuation of therapy occurred in 10/26 (38%) of patients.
CONCLUSIONS: In this cohort of HIV/HCV co-infected patients enrolled in a large observational study and treated with weight-based PEG-IFN alpha-2b (1.5µg/kg/wk) and weight-based RBV (800-1200mg/day), SVR rates were similar to published clinical trials despite the fact that a high proportion of patients had advanced liver disease.
Supported by Schering-Plough