1075 
Does the Choice of NRTI Have a Significant Influence on the Outcome of peg-IFN plus Ribavirin among HIV/HCV-co-infected Patients?
Ana Moreno*1, C Quereda1, A Muriel2, M Perez-Elias1, J Casado1, F Dronda1, M Mateos3, A Moreno4, R Barcena5, and S Moreno1
1Hosp Ramon y Cajal, Madrid, Spain; 2Hosp Ramon y Cajal, Madrid, Spain; 3Hosp Ramon y Cajal, Madrid, Spain; 4Hosp Ramon y Cajal, Madrid, Spain; and 5Hosp Ramon y Cajal, Madrid, Spain
Background: There is much controversy on the role of
NRTI, specially guanosine analogs, on the efficacy of pegylated interferon +
ribivirin (peg-IFN+RBV) among HIV/hepatitis C virus (HCV) –co-infected
patients, due to potential deletereous intracellular interactions with RBV.
Methods: To assess, using individual regression
analyses adjusted for potential confusing variables—baseline HIV viral load,
CD4 counts, HCV RNA level, HCV genotype, the presence of severe fibrosis -F>3-,
and alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) values,
the effect of abacavir (ABC) or tenofovir (TDF) -containing HAART, or the use
of 3 NRTI on the rate of SVR in 174 consecutive, HBVsAg (-), caucasic,
HCV-treatment naïve, HIV-infected patients with chronic hepatitis C starting
their first cycle of peg-IFN plus weight-adjusted RBV. In addition, univariate
and multivariate regression analyses were used to assess baseline predictors of
sustained virological response (SVR) in the whole population.
Results: Peg-IFN-a2a
was used in 53% and peg-IFN-a2b in 47%.
Mean RBV dosage was 14.7±2.4 mg/kg/day. Most subjects were male (76%), prior intravenous
drug users (87%), with a median age of 40 years (28 to 63). The median duration
of HCV infection was 21 years, and 102 (59%) had HCV-genotype 1 or 4. 82% were
on HAART, mostly with protease inhibitors (PI) (n = 70, 49%) or NNRTI (n
= 45, 31.5%); overall, TDF was used in 69 (48%), ABC in 56 (39%), and 3 NRTI in
25 (18%). Baseline CD4 count, and HCV RNA were 513 cells/mL and 5.8 log10
IU/mL, respectively; 67% had HIV RNA <1.7 log10 copies/mL. In
all, 79 patients reached sustained virological response (45%). After each
adjusted regression analysis, neither ABC (p = 0.597), TDF (p = 0.919),
nor 3 NRTI use (p = 0.124) had a significant effect on sustained
virological response. By univariate analysis, baseline HCV RNA (p = 0.0001),
HCV-genotype (p = 0.0001), fibrosis scoring (p = 0.036), baseline
CD4 counts (p = 0.035), and a GGT value ≥100 U/L (p = 0.004)
were associated with sustained virological response. By multivariate analysis,
HCV genotype 1 or 4 (OR 7.801, 95%CI 2.653 to 22.932, p = 0.0001), and
higher baseline HCV RNA levels (OR 3.540, 95%CI 1.704 to 7.353, p = 0.001)
or fibrosis scoring (OR 1.789, 95%CI 1.211 to 2.644, p = 0.003) remained
independently associated with failure to reach sustained virological response.
Conclusions: In our HIV/HCV-cohort, neither ABC- or
TDF-containing HAART, nor the use of 3 NRTI significantly influenced the rate
of sustained virological response in patients receiving peg-IFN + weight-adjusted-RBV.
HCV genotype 1 or 4, and higher HCV RNA levels or fibrosis scoring were
independently associated to treatment failure.
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