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Predictors of response to treatment of chronic hepatitis C infection in HIV-infected patients

Author
David L Wyles, MD
Section Editor
David L Thomas, MD
Deputy Editor
Allyson Bloom, MD

INTRODUCTION

The consequences of hepatitis C virus (HCV) infection in HIV-infected patients are significant and include accelerated liver disease progression, high rates of end-stage liver disease, and shortened lifespan after hepatic decompensation [1]. These observations provide the rationale for treating HCV infection among HIV/HCV-co-infected patients.

This topic will address the predictors of treatment response to therapy of chronic hepatitis C in the HIV-infected patient. The epidemiology, natural history, diagnosis, and treatment of this patient population are discussed elsewhere. (See "Epidemiology, natural history, and diagnosis of hepatitis C in the HIV-infected patient" and "Evaluation of the HIV-infected patient with chronic hepatitis C virus infection" and "Treatment of hepatitis C virus infection in the HIV-infected patient".)

Response to the treatment of acute hepatitis C is discussed in detail elsewhere. (See "Clinical manifestations, diagnosis, and treatment of acute hepatitis C in adults", section on 'Treatment'.)

GENERAL BACKGROUND

The primary goal of therapy is to achieve a sustained virologic response (SVR), which is defined as an undetectable HCV RNA six months after the end of treatment (unless otherwise indicated by a number representing weeks after treatment, eg, SVR12 means 12 weeks after treatment). Viral eradication clearly leads to reduction of morbidity and mortality secondary to liver disease. Predictors of treatment response to pegylated interferon and ribavirin in HIV-infected patients are similar to those reported in patients with HCV alone. Some of these factors may also predict response to treatment with HCV-protease or nucleotide inhibitor based regimens, although their predictive values are likely less overall. (See "Treatment of hepatitis C virus infection in the HIV-infected patient".)

The main pretreatment factors associated with treatment response include HCV genotype, baseline HCV load, liver fibrosis stage, and host genetic factors. As an example, one modeling study based on a cohort of 159 HIV/HCV co-infected patients treated with pegylated interferon and ribavirin suggested that the probability of achieving an SVR with such dual therapy can be reliably estimated prior to initiation of treatment using an index that includes IL-28B genotype, liver stiffness (as measured by elastography), HCV genotype, and viral load [2].

                         

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Literature review current through: Nov 2016. | This topic last updated: Fri Sep 26 00:00:00 GMT+00:00 2014.
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