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Grando AV, Ferreira PRA, Pessôa MG, Mazo DFDC, Brandão-Mello CE, Reuter T, Martinelli ADLC, Gonzalez MP, Nastri ACSS, Campos AF, Lopes MIBF, Brito JDU, Mendes-Corrêa MC. Peginterferon still has a place in the treatment of hepatitis C caused by genotype 3 virus. Rev Inst Med Trop Sao Paulo 2017; 59:e67. [PMID: 29116287 PMCID: PMC5679679 DOI: 10.1590/s1678-9946201759067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023] Open
Abstract
Despite recent advances in therapy for chronic hepatitis C (CHC), the disease caused
by genotype 3 virus (GEN3) is still considered a treatment challenge in certain
patient subgroups. The aim of this retrospective study was to evaluate the
effectiveness and safety of the peginterferon (Peg-IFN) and ribavirin (RBV)
combination treatment for GEN3/CHC patients, and to evaluate sustained virological
response (SVR) indicators and early treatment interruption due to serious adverse
events (SAE). This was a retrospective observational study of GEN3/CHC patients,
co-infected or not by HIV and treated with Peg-IFN/RBV in nine Brazilian healthcare
centers. The study sample included 184 GEN3/CHC patients; 70 (38%) were co-infected
with HIV. The overall SVR rate was 57.1% (95% CI 50-64). Among
co-infected and mono-infected patients, the SVR rate was 51.4% (36/70) and 60.5%
(69/114), respectively (p=0.241). Thirty-four (18.5%) patients experienced SAE and
interrupted treatment. SVR was negatively associated with the use of Peg-IFN alpha 2b
(PR 0.75; 95% CI 0.58-0.99; p=0.045) and to early treatment interruption due to SAE
(PR 0.36; 95% CI 0.20-0.68; p=0.001). Early treatment interruption due to SAE was
associated with age (PR 1.06; 95% CI 1.02-1.10; p<0.001) and occurrence of liver
cirrhosis (PR 2.06; 95% CI 1.11-3.83; p=0.022). In conclusion, Peg-IFN/RBV might
represent an adequate treatment option, mainly in young patients without advanced
liver disease or when the use of direct-action drugs is limited to specific patient
groups.
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Affiliation(s)
- Aline Vitali Grando
- Universidade do Sul de Santa Catarina, Faculdade de Medicina, Departamento de Ciências Biológicas e da Saúde e de Ciências Sociais Aplicadas, Disciplina de Doenças Infecciosas, Palhoça, Santa Catarina, Brazil
| | | | - Mário Guimarães Pessôa
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Gastroenterologia e Hepatologia, São Paulo, São Paulo, Brazil
| | - Daniel Ferraz de Campos Mazo
- Universidade de São Paulo, Faculdade de Medicina, Divisão de Gastroenterologia e Hepatologia, São Paulo, São Paulo, Brazil
| | - Carlos Eduardo Brandão-Mello
- Universidade Federal do Estado do Rio de Janeiro, Departamento de Clinica Médica, Disciplina de Gastroenterologia, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Tânia Reuter
- Universidade Federal do Espírito Santo, Serviço de Infectologia, Vitória, Espírito Santo, Brazil
| | | | | | | | - Aléia Faustina Campos
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Max Igor Banks Ferreira Lopes
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - José David Urbaez Brito
- Secretaria Estadual de Saúde, Unidade Mista de Saúde - Unimista 508/509, Brasília, Distrito Federal, Brazil
| | - Maria Cássia Mendes-Corrêa
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Doenças Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, LIM-52, Laboratório de Virologia, São Paulo, São Paulo, Brazil
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Ferreira PRA, Silva MHD, Brandão-Melo CE, Rezende RE, Gonzalez M, Reuter T, Urbaez JD, Gianini RJ, Martinelli A, Mendes-Correa MC. The clinical effectiveness of pegylated interferon and ribavirin for the treatment of chronic hepatitis C in HIV-infected patients in Brazil: a multicentric study. Braz J Infect Dis 2014; 19:15-22. [PMID: 25181403 PMCID: PMC9425268 DOI: 10.1016/j.bjid.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/09/2014] [Accepted: 08/01/2014] [Indexed: 02/03/2023] Open
Abstract
Introduction 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. Aims 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 600,000 IU/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.
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Affiliation(s)
| | - Mariliza Henrique da Silva
- Centro de Referência e Tratamento DST-AIDS de São Paulo, São Paulo, Brazil; Clínica de Especialidades de São Bernardo do Campo, São Paulo, Brazil
| | | | - Rosamar Eulira Rezende
- Centro de Especialidades - Ambulatório de Hepatites, Secretaria Municipal de Saúde de Ribeirão Preto, São Paulo, Brazil
| | - Mário Gonzalez
- Instituto de Infectologia Emilio Ribas, São Paulo, Brazil
| | - Tânia Reuter
- Disciplina de Infectologia - Universidade Federal do Espírito Santo - UFES, Vitória, Brazil
| | | | - Reinaldo Jose Gianini
- Laboratório de Investigação Médica em Epidemiologia e Estatística, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, Brazil
| | - Ana Martinelli
- Divisão de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Maria Cássia Mendes-Correa
- Departamento de Doenças Infecciosas e Parasitárias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Marcellin F, Roux P, Winnock M, Lions C, Dabis F, Salmon-Ceron D, Loko MA, Spire B, Carrieri MP. Using patient-reported outcomes to improve the management of co-infection with HIV and HCV: the ANRS CO13 HEPAVIH cohort. Expert Rev Gastroenterol Hepatol 2014; 8:351-8. [PMID: 24580042 DOI: 10.1586/17474124.2014.888949] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The management of co-infection with HIV and hepatitis C virus (HCV) is complicated by viral and drug-drug interactions, treatment-related side effects, and the poor response to therapy of certain HCV genotypes. Current or past drug use may also have a negative impact. HEPAVIH (ANRS CO13) is an ongoing French cohort study of co-infected individuals which combines medical and socio-behavioral follow-up. This cohort study aims at analyzing the course of HCV infection and access to HCV treatment in HIV-HCV co-infected patients, using both clinical and patient-reported outcomes. This article documents the main lessons learned to date from the HEPAVIH data and published literature, while describing research prospects and needs requiring further investigation in the field of patient-reported outcomes.
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Vernadakis S, Sotiropoulos GC, Brokalaki EI, Esser S, Kaiser GM, Cicinnati VR, Beckebaum S, Paul A, Mathé Z. Long-term outcomes of liver transplant patients with human immunodeficiency virus infection and end-stage-liver-disease: single center experience. Eur J Med Res 2011; 16:342-8. [PMID: 21813377 PMCID: PMC3351986 DOI: 10.1186/2047-783x-16-8-342] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Objective Orthotopic-liver-transplantation (OLT) in patients with Human-Immunodeficiency-Virus infection (HIV) and end-stage-liver-disease (ESDL) is rarely reported. The purpose of this study is to describe our institutional experience on OLT for HIV positive patients. Material and methods This is a retrospective study of all HIV-infected patients who underwent OLT at the University Hospital of Essen, from January 1996 to December 2009. Age, sex, HIV transmission-way, CDC-stage, etiology of ESDL, concomitant liver disease, last CD4cell count and HIV-viral load prior to OLT were collected and analysed. Standard calcineurin-inhibitors-based immunosuppression was applied. All patients received anti-fungal and anti-pneumocystis carinii pneumonia prophylaxis post-OLT. Results Eight transplanted HIV-infected patients with a median age of 46 years (range 35-61 years) were included. OLT indications were HCV (n = 5), HBV (n = 2), HCV/HBV/HDV-related cirrhosis (n = 1) and acute liver-failure (n = 1). At OLT, CD4 cell-counts ranged from 113-621 cells/μl, and HIV viral-loads from < 50-175,000 copies/ml. Seven of eight patients were exposed to HAART before OLT. Patients were followed-up between 1-145 months. Five died 1, 3, 10, 31 and 34 months after OLT due to sepsis and graftfailure respectively. Graft-failure causes were recurrent hepatic-artery thrombosis, HCV-associated hepatitis, and chemotherapy-induced liver damage due to Hodgkin-disease. One survivor is relisted for OLT due to recurrent chronic HCV-disease but non-progredient HIV-infection 145 months post-OLT. Two other survivors show stable liver function and non-progredient HIV-disease under HAART 21 and 58 months post-OLT. Conclusions OLT in HIV-infected patients and ESLD is an acceptable therapeutic option in selected patients. Long-term survival can be achieved without HIV disease-progression under antiretroviral therapy and management of the viral hepatitis co-infection.
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Affiliation(s)
- S Vernadakis
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany
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Potter M, Klein MB. Co-infections and co-therapies: treatment of HIV in the presence of hepatitis C and hepatitis B. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/17584310.3.2.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
An increasing number of people are chronically infected with HIV and HCV, and/or HBV owing to shared routes of transmission. With the advent of HAART, liver disease secondary to hepatitis co-infections has emerged as a leading cause of morbidity and mortality in HIV-infected persons. There is increasing need to manage dual infection, but treatment is complicated by co-morbidities, overlapping toxicities, drug activities and resistance. A model of treatment that builds on the lessons learned from the treatment of HIV has evolved to maximize success of treating dual infections. This review will address current strategies for the management of HIV in the setting of HCV and HBV co-infection and discuss future treatment directions and challenges.
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Affiliation(s)
- Martin Potter
- Department of Medicine, Divisions of Infectious Diseases/Immunodeficiency, Royal Victoria Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Marina B Klein
- Department of Medicine, Divisions of Infectious Diseases/Immunodeficiency, Royal Victoria Hospital, McGill University Health Centre, Montréal, Québec, Canada
- Montreal Chest Institute, 3650 Saint Urbain Street, Montréal, Quebec H2X 2P4, Canada
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Hanouneh IA, Miller C, Aucejo F, Lopez R, Quinn MK, Zein NN. Recurrent hepatitis C after liver transplantation: on-treatment prediction of response to peginterferon/ribavirin therapy. Liver Transpl 2008; 14:53-8. [PMID: 18161839 DOI: 10.1002/lt.21312] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Sustained virologic response (SVR) in the treatment of recurrent hepatitis C virus (HCV) infection after liver transplantation (LT) remains suboptimal. We evaluated efficacy of pegylated interferon alfa (PEG) and ribavirin (RBV) (PEG/RBV) combination therapy in LT recipients with recurrent HCV and predictive values of rapid virological response (RVR) and early virologic response (EVR). Between January 2001 and October 2005, LT recipients with recurrent HCV were intended to be treated for 48 weeks with PEG/RBV combination therapy independent of genotype or virologic response [53 patients (79% genotype 1)]. On-treatment predictor of response at week 4 (RVR) was defined as undetectable HCV RNA, and at week 12 (EVR) as undetectable HCV RNA or a >2 log(10) drop from pretreatment viral load. SVR was seen in 19 (35%) patients. Patients with genotype 2/3 were more likely to achieve SVR than those with genotype 1 (87% versus 23%; P = 0.001). The highest rate of SVR was seen in patients with RVR [specificity and positive predictive value (PPV) = 100%] while the highest rate of treatment failure was seen in those who did not have EVR [sensitivity and negative predictive value (NPV) = 100%]. The NPV of RVR to identify those who will not achieve SVR was also very high (88%). EVR had low PPV (63%) to identify those with SVR. In conclusion, PEG/RBV combination therapy is effective in the treatment of post-LT recurrent HCV. On-treatment virologic monitoring is highly predictive of SVR and may optimize the virologic response and minimize toxicity. Given its high PPV and NPV, RVR appears to be the most appropriate decision time point for continuation of therapy.
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Affiliation(s)
- Ibrahim A Hanouneh
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, USA
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