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HCV kinetics, quasispecies, and clearance in treated HCV-infected and HCV/HIV-1-coinfected patients with hemophilia.
- Source :
-
Hepatology (Baltimore, Md.) [Hepatology] 2006 Nov; Vol. 44 (5), pp. 1146-57. - Publication Year :
- 2006
-
Abstract
- Hepatitis C virus (HCV) treatment response rates remain low in HCV/HIV-1-coinfected individuals compared with those with HCV alone. Persons with inherited coagulation disorders have high rates of HCV and HIV-1 infection, but HCV treatment trials in this patient population are scarce. We hypothesized that differences by infection status in HCV viral kinetics would be associated with differences in HCV quasispecies complexity over time and with treatment response disparities. Coinfected and monoinfected patients were enrolled in a treatment trial for pegylated-interferon alpha-2a (peg-IFN) + ribavirin. Patients were treated for 48 weeks and followed for an additional 24. Quantitative HCV RNA was tested at multiple times during and after treatment. Viral kinetic parameters associated with response were estimated with a mathematical model. Quasispecies emergence was determined via heteroduplex complexity assay. Twenty-two patients were HCV RNA-positive at baseline, with no significant demographic or virological differences by infection status. Five of eleven (45%) of monoinfected and 3 of 11 (27%) of coinfected patients achieved sustained viral response (SVR). Peg-IFN efficacy (epsilon) of 90% or greater was associated with probability of end-of-treatment response (ETR) (P = .001) and SVR (P = .06). Patients with SVR had lower baseline quasispecies complexity than those without SVR (P = .07). Those with epsilon of 90% or greater also had lower baseline complexity (P = .07). Coinfection status mediated changes in complexity over time (P = .04). In conclusion, low pretreatment quasispecies complexity may predict peg-IFN response; early peg-IFN response is critical for sustained HCV clearance and is altered in coinfection. Further studies are warranted.
- Subjects :
- AIDS-Related Opportunistic Infections complications
AIDS-Related Opportunistic Infections virology
Adult
Alanine Transaminase blood
Antiviral Agents pharmacology
CD4-Positive T-Lymphocytes drug effects
Female
Follow-Up Studies
HIV Infections complications
HIV Infections drug therapy
HIV-1 genetics
Hepatitis C complications
Hepatitis C virology
Humans
Interferon-alpha pharmacology
Male
Middle Aged
RNA, Viral analysis
Remission Induction
Ribavirin pharmacology
Viral Load
AIDS-Related Opportunistic Infections drug therapy
Antiviral Agents therapeutic use
Hemophilia A complications
Hepacivirus drug effects
Hepatitis C drug therapy
Interferon-alpha therapeutic use
Ribavirin therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 0270-9139
- Volume :
- 44
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Hepatology (Baltimore, Md.)
- Publication Type :
- Academic Journal
- Accession number :
- 17058240
- Full Text :
- https://doi.org/10.1002/hep.21374