With the advent of direct-acting antiviral agents, treatment of HCV infection is evolving rapidly. For now, PEG-IFN plus ribavirin remains a standard part of regimens for chronic HCV infection, but the role of ribavirin during acute or early chronic HCV infection remains unclear.

To address that question, researchers conducted the Australian Trial of Acute Hepatitis C, a nonrandomized prospective study of people with recent HCV infection. All study participants received 24 weeks of PEG-IFN, and people coinfected with HIV also received ribavirin. The investigators assessed HCV RNA decline in people with at least 80% adherence.

Of 109 treated people, 57 with HCV alone and 32 with HCV/HIV adhered to their HCV regimen. Overall rapid virologic response rate (HCV RNA below 50 IU/mL at treatment week 4) was 51% and did not differ significantly between people with HCV and those with HCV/HIV (55% versus 43%, P = 0.323). Three factors were independently associated with rapid virologic response: HCV infection for fewer than 26 weeks, pretreatment HCV RNA below 5.6 log10  IU/ml, and HCV genotype 2 or 3 infection versus 1 or 4.

During the first 12 weeks of treatment, HCV RNA declined more on average in HCV/HIV-coinfected people taking PEG-IFN with ribavirin than in HCV-infected people taking only PEG-IFN (4.19 versus 3.32 log10  IU/mL, P  =  0.029). Among people treated with ribavirin, HCV RNA fell most in people infected with HCV for at least 26 weeks and in those with unfavorable IL28B genotypes.

Adherent patients taking or not taking ribavirin had statistically similar early virologic response rates (90% versus 76%, P = 0.102) and sustained virologic response rates (75% versus 63%, P = 0.253). Attaining a rapid virologic response quadrupled chances of sustained virologic response (adjusted odds ratio 4.09, 95% confidence interval 1.49 to 11.25).

The researchers believe their findings “suggest a potential benefit for PEG-IFN and ribavirin combination therapy in maximizing virological responses in HCV/HIV participants with recent HCV, particularly those with a longer duration of HCV infection and unfavourable IL28B genotypes.”

By Mark Mascolini

Source: Jason Grebely, Margaret Hellard, Tanya Applegate, Kathy Petoumenos, Barbara Yeung, Jordan J. Feld, William Rawlinson, Andrew R. Lloyd, Jacob George, John M. Kaldor, Gregory J. Dore, Gail V. Matthews, on behalf of the ATAHC Study Group. Virological responses during treatment for recent hepatitis C virus: potential benefit for ribavirin use in HCV/HIV co-infection. AIDS. 2012; 26: 1653-1661.

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