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Sustained Virological Response to Interferon plus Ribavirin Reduces HIV Progression and Non-liver-related Mortality in Patients Co-infected with HIV and HCV
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Reported by Jules Levin CROI 2010
Juan Berenguer*1, M Crespo2, M Galindo3, M Tellez4, C Barros5, J Guardiola6, R Rubio7, E Barquilla8, J Bellon1, J Gonzalez-García9, and Gesida 3603 Study Group
1Hosp Univ Gregorio Marañon, Madrid, Spain; 2Hosp Univ Bellvitge, Spain; 3Hosp Clin Valencia, Spain; 4Hosp Clin San Carlos, Spain; 5Hosp de Mostoles, Spain; 6Hosp Santa Creu y Sant Pau, Spain; 7Hosp 12 de Octubre, Madrid, Spain; 8Fndn SEIMC-GESIDA, Spain; and 9Hosp Univ La Paz, Madrid, Spain
ABSTRACT
Background: We have previously shown that the achievement of a sustained virological response (SVR) after interferon plus ribavirin (IFN-RBV) therapy in HIV/HCV+ patients reduces liver-related complications and mortality. Here, we assess the impact of SVR after HCV therapy on HIV progression and mortality not related to liver disease.
Methods: We analyzed the GESIDA 3603 Study Cohort, established in Jan 2000 to follow HIV/HCV+ patients, who started IFN-RBV therapy in 20 centers in Spain with active follow-up every 6 months. For the purpose of this study, we measured SVR (ie, undetectable HCV RNA at 24 weeks after the end of treatment), non–liver-related clinical outcomes and mortality, and new AIDS-defining conditions (ADC). The length of the study was calculated from the date SVR or non-SVR was confirmed (day 0), and ended at death or at the last follow-up visit.
Results: Of 1428 HIV/HCV+ patients, 36% had an SVR after IFN-RBV. The table shows the rate of events stratified according to response to IFN-RBV after a median follow-up of 46.6 months (IQR, 29.4 to 64.7).
Cox regression analysis adjusted for fibrosis, CDC clinical category, and nadir CD4+ cell count showed that the adjusted HR of new ADC and deaths not related to liver disease (AIDS and other) was 3.78 (95%CI, 1.48 to 9.65; P = 0.005) for non-SVR in comparison with SVR.
Conclusions: Our results suggest that achievement of an SVR after IFN-RBV therapy in HIV/HCV+ patients reduces not only liver-related complications and mortality, but also HIV progression and mortality not related to liver disease. These findings may be associated with a poorer immune response and/or complications of HCV viremia in patients that did not achieve SVR
different paper presented at CROi supporting idea that in Non-SVR patients immune system may be dysregulated. (from Jules: inflammation)
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