title: The clinical effectiveness of pegylated interferon and ribavirin for the treatment of chronic hepatitis C in HIV-infected patients in Brazil: a multicentric study.
abstract: BACKGROUND
  in Brazil, chronic hepatitis C in patients coinfected with the human immunodeficiency virus (HIV) is treated with pegylated interferon (Peg-IFN) and ribavirin (RBV). However, few studies have evaluated the effectiveness of this treatment in this particular population. The identification of the factors that predict sustained virological response (SVR) under current clinical practice would enable clinicians to more accurately estimate the probability of achieving an SVR and therefore utilize the appropriate therapeutics, especially in the era of direct-acting antiviral (DAA) agents.
  
  
  OBJECTIVE
  the primary aim of our study was to determine the SVR rate under current clinical practice. The secondary aims were as follows: (1) to determine the factors before and during treatment that predict SVR; and (2) to identify the causes of treatment interruption.
  
  
  METHODS
  within a cohort of HIV/hepatitis C virus (HCV)-coinfected patients in Brazil, we performed a retrospective analysis of those individuals treated with Peg-IFN and RBV.
  
  
  RESULTS
  among the 382 analyzed patients, SVR was observed in 118 [30.9% (95% confidence interval (CI): 26.3-35.8)], which included 25.9% (75/289) of the patients with genotypes 1 and 4 and 48.2% (41/85) of those with genotypes 2 and 3. After multivariate analyses the independent positive predictors for SVR after treatment for chronic hepatitis C with Peg-IFN and RBV were: absence of an AIDS-defining illness (p=0.001), HCV viral load lower than 600,000IU/mL at the onset of treatment (p=0.003), higher liver enzyme levels (p=0.039) at baseline, infection with genotypes 2 or 3 (p=0.003), and no transient treatment interruption (p=0.001). The treatment was interrupted in 25.6% (98/382) of the patients because of adverse events (11.3%, 43/382), virologic failure (7.8%, 30/382), and dropout (6.5%, 43/382). The main adverse events were cytopenia and psychiatric disorders.
  
  
  CONCLUSIONS
  in our Brazilian case series, the SVR rate under current clinical practice conditions was similar to that reported in other studies. There was a correlation between an SVR and being infected by genotypes 2 and 3, low viral load, high ALT levels at the onset of treatment, and absence of an AIDS-defining illness. Cytopenia and psychiatric disorders were the major causes of treatment interruption. Efforts should be focused on optimizing management of side effects and counseling to improve adherence and to keep patients on treatment.
authors.affiliation: Disciplina de Infecologia Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil. Electronic address: paulo.abrao.ferreira@gmail.com.
authors.forename: Paulo Roberto Abrão
authors.initials: PR
authors.lastname: Ferreira
authors.affiliation: Centro de Referência e Tratamento DST-AIDS de São Paulo, São Paulo, Brazil; Clínica de Especialidades de São Bernardo do Campo, São Paulo, Brazil.
authors.forename: Mariliza Henrique da
authors.initials: MH
authors.lastname: Silva
authors.affiliation: Universidade Federal do Estado do Rio de Janeiro - UNIRIO, Rio de Janeiro, Brazil.
authors.forename: Carlos Eduardo
authors.initials: CE
authors.lastname: Brandão-Melo
authors.affiliation: Centro de Especialidades - Ambulatório de Hepatites, Secretaria Municipal de Saúde de Ribeirão Preto, São Paulo, Brazil.
authors.forename: Rosamar Eulira
authors.initials: RE
authors.lastname: Rezende
authors.affiliation: Instituto de Infectologia Emilio Ribas, São Paulo, Brazil.
authors.forename: Mário
authors.initials: M
authors.lastname: Gonzalez
authors.affiliation: Disciplina de Infectologia - Universidade Federal do Espírito Santo - UFES, Vitória, Brazil.
authors.forename: Tânia
authors.initials: T
authors.lastname: Reuter
authors.affiliation: Unidade Mista de Saúde - Unimista 508/509, SES-DF, Brasília, Brazil.
authors.forename: Jose David
authors.initials: JD
authors.lastname: Urbaez
authors.affiliation: Laboratório de Investigação Médica em Epidemiologia e Estatística, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, Brazil.
authors.forename: Reinaldo Jose
authors.initials: RJ
authors.lastname: Gianini
authors.affiliation: Divisão de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, Brazil.
authors.forename: Ana
authors.initials: A
authors.lastname: Martinelli
authors.affiliation: Departamento de Doenças Infecciosas e Parasitárias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Maria Cássia
authors.initials: MC
authors.lastname: Mendes-Correa
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005838:Genotype; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011092:Polyethylene Glycols / Q000008:administration & dosage* / Q000009:adverse effects; D012367:RNA, Viral; D011994:Recombinant Proteins / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D012254:Ribavirin / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D012367:RNA, Viral; D011994:Recombinant Proteins; D011092:Polyethylene Glycols; D012254:Ribavirin; C417083:peginterferon alfa-2b
keywords: HCV; HIV; Interferon; Ribavirin