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A triple therapy increases the sustained virological response in patients co-infected with HIV and hepatitis C virus

About a third of people infected with HIV in the USA and Europe are also infected with hepatitis C virus (HCV). A work published in The Lancet Infectious Diseases suggests a novel combination of drugs, already used successfully in HCV patients, which achieves a better sustained virological response in co-infected patients too. Dr. Josep Mallolas, from the AIDS and Infectious Diseases team at IDIBAPS - Hospital Clínic of Barcelona, is the third author of this work coordinated from the Johns Hopkins University School of Medicine (Baltimore, USA) and funded by Merck.

In patients with HIV and HCV baseline HCV levels are higher and the progression of the disease is faster, leading to an increased risk of cirrhosis, end-stage liver disease, and hepatocellular carcinoma. Additionally, the rates of response to treatment against HVC are low in patients with HCV genotype 1 and HIV. The new triple therapy included boceprevir plus pegylated interferon alfa-2b (peginterferon) and ribavirin, a combination which increases rates of sustained virological response in patients with HCV alone. In a double-blind, randomised controlled phase 2 trial, researchers from 30 academic and non-academic study sites located at USA, Spain, France, Argentina and Canada enrolled 99 adults with untreated HCV genotype 1 infection and controlled HIV. The treatment of the study group and the control group lasted 44 weeks.

After a follow up period, 63% of patients in the boceprevir group had a sustained virological response, compared with 29% of control patients. Although adverse events were more common in patients who received boceprevir, the benefits of increasing the treatment efficiency may overcome the inconveniences. Eradication of HCV reduces hepatic and extrahepatic morbidity and mortality in patients infected with both viruses. That is the reason why the boceprevir in combination with peginterferon–ribavirin treatment suggested by international investigators in The Lancet Infectious Diseases could be an important therapeutic option for patients with HCV and HIV.

Reference: Sulkowski M, Pol S, Mallolas J, Fainboim H, Cooper C, Slim J, Rivero A, Mak C, Thompson S, Howe AY, Wenning L, Sklar P, Wahl J, Greaves W; P05411 study investigators. Boceprevir versus placebo with pegylated interferon alfa-2b and ribavirin for treatment of hepatitis C virus genotype 1 in patients with HIV: a randomised, double-blind, controlled phase 2 trial. Lancet Infect Dis. 2013 Jul;13(7):597-605. doi: 10.1016/S1473-3099(13)70149-X. Epub 2013 Jun 12. Read the Abstract