Effect of Accompanying Antiretroviral Drugs on Virologic Response to PEG-IFN and Ribavirin

17th CROI
Conference on Retroviruses
and Opportunistic Infections
San Francisco CA
February 16-19, 2010 Back grey_arrow_rt.gif





Effect of Accompanying Antiretroviral Drugs on Virologic Response to PEG-IFN and Ribavirin in HIV/HCV Co-infected Patients: 'AZT not good, abacavir ok'


Reported by Jules Levin
CROI 2010 Feb 16-19 SF

Juan Berenguer*1, M von Wichmann2, C Quereda3, P Miralles1, J Mallolas4, J Lopez Aldeguer5, J Alvarez Pellicer6, J De Miguel7, J Bellon1, J Gonzalez-Garcia6, and GESIDA 36/03 and 50/06 Study Groups 1Hosp Gen Univ Gregorio Maranon, Madrid, Spain; 2Hosp Donostia, Spain; 3Hosp Ramon y Cajal, Spain; 4Hosp Clin, Barcelona, Spain; 5Hosp Univ La Fe, Valencia, Spain; 6Hosp Univ La Paz, Madrid, Spain; and 7Hosp Principe de Asturias, Spain

AUTHOR CONCLUSION
Our results suggest that, with the exception of regimens including AZT, accompanying antiretroviral drugs have little effect on virologic response to PEG-IFN + RBV in HIV/HCV+ patients. We did not find ABC to negatively impact the outcome of PEG-IFN + RBV therapy even in difficult-to-treat patients such as those with genotypes 1 and 4 and high HCV-RNA.

ABSTRACT

Background: The effect of accompanying antiretroviral drugs (ART-D) on virologic response to PEG-interferon (IFN) plus ribavirin (RBV) remains uncertain. We evaluated the effect of ART-D, particularly abacavir (ABC), on the response to PEG-IFN and RBV in HIV/HCV-co-infected Patients

Methods: We conducted a retrospective analysis of 2 cohorts of HIV/HCV-coinfected patients initiating PEG-IFN and RBV between January 2001 and June 2007 at 45 centers in Spain (GESIDA 3603 and GESIDA 5006). The study outcome measure was sustained virologic response (SVR), defined as an undetectable HCV viral load 24 weeks after discontinuation of PEG-IFN and RBV. Logistic regression models were used to test possible associations between nonresponse and pretreatment characteristics, including ART-D. All analyses were performed on an ITT basis.

Results: A total of 1701 patients were included, 63% were infected by genotype (G) 1-4, 88% were taking HAART. Factors independently associated with increased odds of SVR were G2-3, HVC-RNA < 500K IU/mL and CDC clinical category A or B. When we adjusted for CDC clinical category, G, HVC-RNA, and RBV/kg, the adjusted odds ratio (AOR) of SVR for patients without HAART was 1.31 (95%CI, 0.91 to 1.88; P =0.144). Taking the backbone of TDF+3TC/FTC as our reference, the AOR of SVR of the different NRTI backbones were as follows:


No significant differences were found between the different backbones when we repeated this analysis for patients receiving RBV < 800 mg/kg, < median, and < 1st quartile. Similarly, no significant differences were found between the different backbones when we analyzed the subgroup of patients with G1-4 and HCV-RNA>500K adjusted for CDC clinical category and/or RBV/kg.

Conclusions: Our results suggest that, with the exception of regimens including AZT, ART-D has little effect on virologic response to PEG-IFN plus RBV in HIV/HCV-co-infected patients. In this context, ABC does not compromise the outcome of HCV therapy.