title: Impact of ribavirin exposure on early virological response to hepatitis C therapy in HIV-infected patients with chronic hepatitis C.
abstract: BACKGROUND
  The use of pegylated interferon (PEG-IFN) plus ribavirin (RBV) is currently the recommended treatment for chronic hepatitis C virus (HCV) infection. Coinfection with HIV is a negative predictor of response, for reasons not well understood.
  
  
  METHODS
  We examined the virological response at weeks 4 and 12 in 198 HCV/HIV-coinfected patients enrolled in a prospective trial in which PEG-IFN alpha 2a (180 microg per week) and RBV (1000-1200 mg daily) were provided.
  
  
  RESULTS
  In an on-treatment analysis, 52.8% of patients achieved undetectable HCV-RNA (<600 IU/ml) at week 4, while 63% and 77.2% of patients had a decline of at least 2 and 1 log10, respectively. At week 12, 73.1% of patients reached undetectable HCV-RNA, and 83.5% and 89% achieved at least a 2- and 1-log10 drop, respectively. More than 85% of HCV genotypes 2/3 cleared HCV-RNA at week 4, a proportion significantly higher when compared with genotypes 1 (33.8%) and 4 (28.6%). Multivariate logistic regression analysis identified genotype 3 and RBV exposure (mg/kg of body weight) as independent predictors of virological response at week 12 of therapy.
  
  
  CONCLUSIONS
  Early virological response rates to PEG-IFN plus RBV in HCV/HIV-coinfected patients seem to be similar to those reported for HCV-monoinfected subjects. The use of suboptimal doses of RBV in most earlier trials might account for the low response rates seen in coinfected patients. To our knowledge, this is the first report demonstrating that RBV exerts a significant independent effect on early virological response. Therefore, strategies aimed at optimizing doses and adherence to RBV might help to improve responses to HCV therapy in coinfected patients.
authors.affiliation: Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Núnez
authors.forename: Nuria
authors.initials: N
authors.lastname: Camino
authors.forename: Belén
authors.initials: B
authors.lastname: Ramos
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Berdún
authors.forename: Pablo
authors.initials: P
authors.lastname: Barreiro
authors.forename: Elena
authors.initials: E
authors.lastname: Losada
authors.forename: Ignacio
authors.initials: I
authors.lastname: Santos
authors.forename: Santiago
authors.initials: S
authors.lastname: Echevarría
authors.forename: Antonio
authors.initials: A
authors.lastname: Ocampo
authors.forename: Celia
authors.initials: C
authors.lastname: Miralles
authors.forename: Piedad
authors.initials: P
authors.lastname: Arazo
authors.forename: Luz
authors.initials: L
authors.lastname: Martín-Carbonero
authors.forename: Miriam
authors.initials: M
authors.lastname: Romero
authors.forename: Javier
authors.initials: J
authors.lastname: García-Samaniego
authors.forename: Vincent
authors.initials: V
authors.lastname: Soriano
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000150:complications*; D016174:Hepacivirus / Q000235:genetics / Q000302:isolation & purification*; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007279:Injections, Subcutaneous; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D012367:RNA, Viral / Q000032:analysis; D011994:Recombinant Proteins; D012254:Ribavirin / Q000008:administration & dosage / Q000627:therapeutic use*; D013030:Spain; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D012254:Ribavirin