Rate and predictors of serum HCV-RNA >6 million IU/mL in patients with chronic hepatitis C.

Background Baseline serum HCV-RNA predicts sustained virological response in chronic hepatitis C patients treated with antiviral therapy. A threshold at 6 million IU/mL has been proposed to best discriminate treatment outcomes on sofosbuvir-based regimens. In comparison with the general population, immunosuppressed individuals exhibit greater viral load values. Objectives To estimate the rate and predictors of serum HCV-RNA above 6 million IU/mL in chronic hepatitis C patients on care outside clinical trials. Study design Serum HCV-RNA values recorded from all chronic hepatitis C patients consecutively attended at our clinic during the last decade were analyzed. Testing had been performed using the COBAS TaqMan HCV test v2.0. Results A total of 816 individuals with detectable serum HCV-RNA were identified. The main characteristics of this population were as follows: mean age 48.6 years-old; 73.4% males; mean ALT 82.6 IU/L; mean HCV-RNA 6.02 log IU/mL; 80.6% HCV genotypes 1 or 4; 34.9% advanced liver fibrosis; 35.4% IL28B-CC alleles. HIV coinfection in 78.7%, of whom 91% were on antiretroviral therapy. Overall, 127 (15.6%) had serum HCV-RNA values >6 million IU/mL. This high viremia was found in 18.2% of HIV-positive versus 5.7% of HIV-negative subjects ( p < 0.001). In multivariate analysis, serum HCV-RNA >6 million IU/mL was only significantly associated with HIV coinfection (OR: 4.03; 95% CI: 1.98–8.19, p < 0.01) and HCV genotypes 1 or 4 (OR: 1.88; 95% CI: 1.05–3.37, p = 0.03). Conclusions Serum HCV-RNA >6 million IU/mL is roughly seen in 6% of chronic hepatitis C monoinfected patients, and increases up to 18% in HIV coinfection. [ABSTRACT FROM AUTHOR]