Management of HIV/hepatitis C virus-coinfected patient non-responders to hepatitis C virus antiviral therapy and relapsers.
OBJECTIVE
To examine recent developments in the management of HIV/hepatitis C virus-coinfected patients who relapsed or who responded poorly to initial therapy, with particular emphasis on peginterferon plus ribavirin.


RESULTS
End-stage liver disease is the first cause of non-AIDS-related mortality in patients on antiretroviral therapy. A pool analysis of recent studies suggested that only 33% of HIV/hepatitis C virus-coinfected patients will achieve sustained virological response with peginterferon plus ribavirin. A substudy of the APRICOT trial shows that this strategy will benefit liver histology even in non-responding patients. The management of side effects is important and, according to a recent study, erythropoietin can improve clinical outcomes of hepatitis C virus therapy, although no direct association between response and the control of haematological toxicity was demonstrated. Patients who did not clear hepatitis C virus RNA with a slow virological response to previous courses of peginterferon and ribavirin might benefit from prolonging therapy to up to 72 weeks.


CONCLUSIONS
Re-treatment strategies in non-responders to previous interferon-based therapies and relapsers should consider the previous virological response profile and ensure that treatment-related toxicity is controlled to avoid dose reductions or premature treatment interruptions. Further studies are needed to optimize therapeutic regimens.
Tural
Cristina
C
aHIV Clinical Unit, Internal Medicine Department, University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain bHepatology Unit, Gastroenterology Service, University Hospital Germans Trias i Pujol, Universitat Autònoma de Barcelona, Barcelona, Spain cIrsicaixa foundation, University Hospital Germans Trias I Pujol, Universitat Autónoma de Barcelona, Barcelona, Spain.
Planas
Ramon
R
Sirera
Guillermo
G
Clotet
Bonaventura
B