Treating hepatitis C in HIV/HCV co-infected patients in Malaysia- the outcomes and challenges
- Author:
Soek Siam Tan
;
Chee Loon Leong
;
Christopher Kwok Chong Lee
- Publication Type:Journal Article
- Keywords:
Sustained virological response;
HIV/HCV co-infection;
Pegylated interferon and Ribavirin;
Injecting drug use
- MeSH:
HIV;
Hepacivirus
- From:
The Medical Journal of Malaysia
2015;70(5):281-287
- CountryMalaysia
- Language:English
-
Abstract:
Background: Co-infection by human immunodeficiency and
hepatitis C viruses (HIV/HCV) is common and results in
significant morbidity and mortality despite effective antiretroviral
therapies (ART).
Method: A retrospective and prospective evaluation of the
efficacy and safety of pegylated interferon alfa 2a/2b plus
ribavirin (PEG-IFN/RBV) in consecutive HIV/HCV co-infected
patients treated in real life clinical practice in Malaysia.
Results: Forty-five HIV/HCV co-infected patients with a
median age (interquartile range, IQR) of 41 years (37; 47)
were assessed for treatment with PEG-IFN/RBV. All except
one are of male gender and the most common risk behaviour
was injecting drug use. At baseline 75.5% was on ART and
the median (IQR) CD4 count was 492 cells/µl (376; 621). The
HCV genotypes (GT) were 73 % GT3 and 27% GT1. Liver
biopsies in forty patients showed 10% had liver cirrhosis
and another 50% had significant liver fibrosis. The treatment
completion rate was 79.5% with 15.9% dropped out of
treatment due to adverse effects (AE) or default and 4.6%
due to lack of early virological response. The AE causing
premature discontinuations were neuropsychiatric and
haematological. The overall sustained virological response
(SVR) was 63.6% with a trend towards higher SVR in GT3
compared with GT1 (71.9% vs. 41.7%; p=0.064). In patients
with bridging fibrosis plus occasional nodules or cirrhosis
on liver biopsy, the SVR was significantly lower at 20%
(p=0.030) compared to those with milder fibrosis.
Conclusion: HIV/HCV co-infected patients can be
successfully and safely treated with PEG-IFN/RBV achieving
high rates of SVR except in cirrhotic patients.
- Full text:P020151109532518031308.pdf
