How well does HCV treatment work for people with HIV?
Almost all of what we know about treating hepatitis C in people living with HIV comes from clinical trials exploring the safety and effectiveness of pegylated interferon plus ribavirin alone, with HCV protease inhibitors.
Unfortunately, we also know that pegylated interferon combined with ribavirin is less effective in coinfected people, compared with those living with hepatitis C but not HIV.
Responses to pegylated interferon/ribavirin treatment vary by HCV genotype: For HIV/HCV-coinfected people with HCV genotype 1, sustained virological response (SVR) rates in clinical trials ranged from 14 percent to 38 percent. For people with HCV genotypes 2 and 3, SVR rates in clinical trials have been between 44 percent and 73 percent.
Preliminary results from studies exploring the effectiveness of pegylated interferon and ribavirin plus either Incivek or Victrelis are available. According to these clinical trials, the addition of either protease inhibitor improves SVR rates by roughly 30 percent in people living with HIV and genotype 1 HCV.
HCV treatment is more likely to work for people with HIV when:
They have an RVR (HCV viral load is undetectable after four weeks of treatment).
They have a cEVR or pEVR (HCV is either undetectable or has dropped by at least 2 logs, which is 99 percent, by week 12). It is important for people to be evaluated after three months (12 weeks) on treatment. If their HCV viral load hasn’t dropped significantly, treatment is stopped since this indicates that they’re very unlikely to achieve a sustained response.
They are given weight-based ribavirin, or at least 800 mg per day. However, ribavirin has a number of side effects, including low red and white blood cell counts, which appear to be worse in HIV-positive people. In turn, it can be challenging to remain on a high enough dose of ribavirin to push HCV viral load to undetectable—and to keep it there.
They properly manage the side effects.
Last Revised: April 03, 2012
This content is written by the POZ and AIDSmeds editorial team. For more information, please visit our "About Us" page.