Hepatitis C virus/human immunodeficiency virus coinfection in hemophiliacs : high rates of sustained virologic response to pegylated interferon and ribavirin therapy

Background: Progression of chronic hepatitis C virus (HCV) infection to end-stage liver disease is accelerated in patients coinfected with human immunodeficiency virus (HIV). HCV/HIV-coinfected hemophiliacs are no exception. Although eradication of HCV with pegylated interferon (Peg-IFN) plus ribavirin (Rbv) is the only approach to halt the progression of liver disease, the rates of sustained virologic response (SVR) in coinfected patients are attenuated as compared with those in HCV-monoinfected patients. Nonetheless, in HCV-infected hemophiliacs, who are considered to constitute a difficult-to-treat population, current treatment strategies yielded rates of SVR similar to those obtained in non-hemophiliacs. Objectives and patients: In this open-label, prospective, multicenter study, the efficacy and safety of therapy with Peg-IFNα2a plus Rbv was evaluated in 34 HCV/HIV-coinfected adult hemophiliacs naive to previous antiviral therapy. Methods: Peg-IFNα2a was administered at a dose of 180μg subcutaneously once-weekly plus oral Rbv 1000-1200mgday -1 for 48 weeks, irrespective of HCV genotype. Results: All but one patient (3%) completed the study, 15 (44%) achieved an SVR, and 13 (38%) required dose reduction of either drug. A rapid virologic response (HCV-RNA clearance at week 4; P=0.01), a complete early virologic response (HCV RNA clearance at week 12; P=0.005) and absence of cirrhosis (P=0.04) were independent predictors of SVR. During a median post-treatment follow-up of 3 years, a steady increase in CD4+ cell count and CD4+/CD8+ cell ratio was observed in SVR patients. Conclusions: These results strongly support the use of anti-HCV therapy in HCV/HIV-coinfected hemophiliacs.