1070 
Frequency of RVR and Its Utility as a Predictor of Treatment Outcome In HIV+ and HIV- Individuals with Acute Hepatitis C
Gail Matthews*1, M Hellard2, P Haber3, B Yeung1, D Baker4, A Lloyd5, W Rawlinson6, J Sasadeusz7, J Kaldor1, G Dore1, and on behalf of the ATAHC Study Group
1Natl Ctr for HIV Epidemiology and Clin Res, Univ of New South Wales, Australia; 2Macfarlane Inst for Med Res and Publ Hlth, Melbourne, Australia; 3Drug Hlth Svc, Royal Prince Alfred Hosp, Sydney, Australia; 4407 Doctors, Sydney, Australia; 5Univ of New South Wales, Sch of Med Sci, Sydney, Australia; 6SEALS Microbio, Prince of Wales Hosp, Sydney, Australia; and 7Royal Melbourne Hosp, Australia
Background: Undetectable
HCV RNA at week 4 (rapid virological response, RVR) is increasingly used as a
predictor of treatment outcome in chronic HCV. Its utility in HIV-co-infected
subjects with acute hepatitis C (AHC) has not been described. The Australian
Trial in Acute Hepatitis C examined the RVR rate and its utility as a predictor
of therapy outcome in AHC.
Methods: All
HCV RNA-positive subjects at screening were assessed for HCV treatment: 24 weeks
of pegylated interferon-alfa-2a (PEG) for HCV mono-infection and 24 weeks PEG
and ribavirin (RBV) for HIV co-infection.
Results: Of
140 subjects enrolled to date, 96 (69%) elected to undergo AHC treatment
including 28 (29%) with HIV co-infection. Treated HIV/HCV subjects were more
likely than HCV mono-infected subjects to be male (100% vs 62%, p = 0.003),
older (41 vs 30 years, p <0.001) and have baseline HCV RNA >400,
000 IU/mL (57% vs 31%, p = 0.016). HCV genotype (GT) 1 occurred in 61% of
HIV/HCV and 51% of HCV mono-infected subjects (p = 0.633). The rate of documented
HCV seroconversion illness was similar (46% HIV/HCV vs 44% HCV, p = 0.883),
although median estimated duration of infection was shorter in the HIV/HCV
group (17 vs 27 weeks, p = 0.015). Of 80 subjects with week-4 results, RVR
was observed in 9 of 23 (39%) of HIV/HCV and 28 of 57 (49%) of HCV-mono-infected
subjects (p = 0.417). Failure to achieve RVR was associated with baseline
HCV RNA >400,000 (58% in non-RVR vs 19% in RVR, p <0.001), but not
with median estimated duration of infection (23 weeks non-RVR vs 30 weeks RVR, p
= 0.493). GT 1 infection was borderline significant for non-RVR (63% vs 41%, p
= 0.079). Predictability of RVR was assessed in 49 subjects through to sustained
virologic response who had both RVR and sustained
virologic response assessment available (15 HIV, 34 HCV mono-infection).
Sustained virologic response was achieved in 100% of
subjects with RVR (n = 24) and 56% among those without RVR (n = 25).
The positive and negative predictive values of RVR were 100% and 44%,
respectively. Positive and negative predictive values were identical in HCV and
HIV/HCV subjects.
Conclusions: AHC treated individuals with an RVR are highly likely to achieve an sustained
virologic response, irrespective of HIV status. Strategies
involving shorter therapy in these subjects may be possible. Alternative
therapeutic strategies should be explored for individuals with baseline
characteristics predictive of non-RVR or those with non-RVR on current standard
AHC therapy.
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