898 
Antiretroviral Regimens including Tenofovir or Stavudine + Lamivudine as NRTI Backbone Are Associated with Higher Sustained Virological Response Rate to Pegylated Interferon and Ribavirin Treatment in HIV/HCV-co-infected Patients
José A. Mira*1, R Carrillo-Gómez2, A Gutierrez-Valencia3, D Merino4, A Rivero5, J Girón-González6, M Ríos-Villegas7, A Collado8, M Torres-Tortosa9, J Pineda1, and Grupo Andaluz para el Estudio de las Enfermedades Infecciosas (GAEI)
1Hosp Univ de Valme, Sevilla, Spain; 2Hosp Univ de la Princesa, Madrid, Spain; 3Hosp Univ Virgen del Rocio, Sevilla, Spain; 4Hosp Juan Ramon Jimenez, Huelva, Spain; 5Hosp Univ Reina Sofía, Cordoba, Spain; 6Hosp Univ Puerta del Mar, Cadiz, Spain; 7Hosp Univ Virgen Macarena, Sevilla, Spain; 8Hosp Torrecardenas, Almeria, Spain; and 9Hosp Punta Europa, Cadiz, Spain
Background: Different prognostic factors,
such as HCV genotype 2 or 3 and low baseline HCV RNA level, have been associated with higher
sustained virological response rates among HIV/HCV-co-infected patients receiving
pegylated interferon (pegIFN) + ribavirin
(RBV). However,
little information is available about the effect of HAART on the efficacy of pegIFN + RBV in these individuals. The aim of this study
was to investigate the influence of different antiretroviral drugs on the sustained
virological response to pegIFN
+ RBV treatment in patients with HIV and HCV co-infection.
Methods: All HIV/HCV-co-infected patients
who received pegIFN + RBV from June 2000 to February
2006 were included in a Spanish multi-center study. The outcome variable was
the rate of sustained virological response, defined
as undetectable HCV RNA in serum at 24 weeks after cessation of the therapy. Different
ART drug families, individual ART drugs and HAART combinations were included in
a univariate and a multiple logistic regression analysis.
Results: A total of 310 HIV/HCV-co-infected patients who attended the
participating hospitals were included in the study, of whom 258 (83%) received
HAART during pegIFN + RBV therapy. Sustained virological response was reached in 114 (37%) patients. Of individuals
who discontinued the therapy, 40 (13%) did so because of adverse events, and 24
(8%) did so due to their own decision. Among the 196 subjects
with genotype 1 or 4, 46 (23%) achieved sustained virological
response, whereas 68 (60%) of 114 individuals carrying genotypes 2 or 3 did so.
Of other subjects who reached sustained virological
response, 47 (44%) used tenofovir (TDF) or stavudine
(d4T) + lamivudine (3TC) as a nucleoside reverse
transcriptase inhibitor (NRTI) backbone; 44 (29%) used other HAART combinations;
and 23 (44%) used no HAART. In the multivariate analysis, HCV genotype 2-3 (adjusted
odds ratio [AOR] 4.7, 95%CI 2.7 to 8), adherence to therapy >80% (AOR 3.6,
95%CI 1.4 to 9.1), baseline HCV RNA ≤600,000 copies/mL
(AOR 2.1, 95%CI 1.2 to 3.6), baseline CD4+ cell counts >300
cells/mm3 (AOR 3.4, 95%CI 1.1 to 10.1), HAART with TDF or d4T + 3TC
as NRTI backbone (AOR 2.0, 95% 1.1 to 4.3), and no use of HAART (AOR 2.0, 95%
1.1 to 3.7) were independently associated with sustained virological
response.
Conclusions: HAART with a NRTI backbone that includes TDF or d4T + 3TC is associated
with higher sustained virological response rate than
other HAART combinations among HIV/HCV-co-infected patients treated with pegIFN + RBV treatment.
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