title: Treating hepatitis C in HIV/HCV co-infected patients in Malaysia - the outcomes and challenges.
abstract: BACKGROUND
  Co-infection by human immunodeficiency and hepatitis C viruses (HIV/HCV) is common and results in significant morbidity and mortality despite effective antiretroviral therapies (ART).
  
  
  METHODS
  A retrospective and prospective evaluation of the efficacy and safety of pegylated interferon alfa 2a/2b plus ribavirin (PEG-IFN/RBV) in consecutive HIV/HCV co-infected patients treated in real life clinical practice in Malaysia.
  
  
  RESULTS
  Forty-five HIV/HCV co-infected patients with a median age (interquartile range, IQR) of 41 years (37; 47) were assessed for treatment with PEG-IFN/RBV. All except one are of male gender and the most common risk behaviour was injecting drug use. At baseline 75.5% was on ART and the median (IQR) CD4 count was 492 cells/μl (376; 621). The HCV genotypes (GT) were 73 % GT3 and 27% GT1. Liver biopsies in forty patients showed 10% had liver cirrhosis and another 50% had significant liver fibrosis. The treatment completion rate was 79.5% with 15.9% dropped out of treatment due to adverse effects (AE) or default and 4.6% due to lack of early virological response. The AE causing premature discontinuations were neuropsychiatric and haematological. The overall sustained virological response (SVR) was 63.6% with a trend towards higher SVR in GT3 compared with GT1 (71.9% vs. 41.7%; p=0.064). In patients with bridging fibrosis plus occasional nodules or cirrhosis on liver biopsy, the SVR was significantly lower at 20% (p=0.030) compared to those with milder fibrosis.
  
  
  CONCLUSIONS
  HIV/HCV co-infected patients can be successfully and safely treated with PEG-IFN/RBV achieving high rates of SVR except in cirrhotic patients.
authors.affiliation: Selayang Hospital, Department of Hepatology, Selangor, Malaysia,. bkho67@gmail.com.
authors.forename: S S
authors.initials: SS
authors.lastname: Tan
authors.affiliation: Hospital Kuala Lumpur Jalan Pahang, Kuala Lumpur, Wilayah Persekutuan 50586 Malaysia.
authors.forename: C L
authors.initials: CL
authors.lastname: Leong
authors.affiliation: Sungai Buloh Hospital, Department of Infectious Diseases, Selangor, Malaysia.
authors.forename: C K C
authors.initials: CK
authors.lastname: Lee