Long-term efficacy of combination therapy with interferon-α2b and ribavirin for severe chronic hepatitis C in HIV-infected patients

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Abstract
We have assessed the long-term efficacy and safety of a combination therapy of interferon alpha-2b (IFN) and ribavirin (RBV) for the treatment of severe chronic hepatitis C in co-infected HIV-seropositive patients in an open prospective study. Fifty-one patients were treated for 12 months. Mean baseline CD4 cell count, alanine aminotransferase and aspartate aminotransferase were 412 ± 232 × 106/l, 113 ± 75 IU/l and 111 ± 84 IU/l respectively. The mean Knodell score was 11.5 ± 2.1 with 28 patients (55%) exhibiting histological evidence of active cirrhosis. Fifteen (29%) patients discontinued the treatment prematurely because of adverse events. An end of treatment response (ETR) as defined by the lack of detectable hepatitis C virus (HCV) RNA in plasma at the end of treatment was achieved in 15 patients (29%). A sustained virological response (SVR), defined by the lack of detectable HCV RNA in plasma 6 months after completion of combination therapy, was achieved in 11 patients (21%). The HCV genotype 3a was associated with ETR and SVR (P = 0.002 and P = 0.003, respectively). HCV viraemia at baseline was lower in patients who achieved SVR and ETR than in those who did not (6.7 ± 7.8 versus 24 ± 26.7 × 106 genome equivalents/ml, P = 0.03 and 14.3 ± 28.7 versus 22.5 ± 23, P = 0.05, respectively). Our results indicate that combination therapy with IFN and RBV is effective in approximately 20% of co-infected patients with severe liver disease.