Z Gastroenterol 2013; 51 - A31
DOI: 10.1055/s-0033-1347406

The impact of interleukin 28B rs12979860 single nucleotide polymorphism and liver fibrosis stage on response-guided therapy in HIV/HCV-coinfected patients

M Mattias 1, T Reiberger 1, BA Payer 1 M Peck-Radosavljevic 1, Vienna HIV & Liver Study Group
  • 1Klinische Abteilung für Gastroenterologie und Hepatologie, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Austria

Objective:

According to the European AIDS Clinical Society guidelines for response-guided therapy (RGT) of chronic hepatitis C virus (HCV) infection in HIV-positive patients, HCV-genotype (GT) and rapid virologic response (RVR) exclusively determine the duration of antiviral therapy with pegylated interferon plus ribavirin (PEGIFN+RBV). The aim of this study was to investigate the impact of interleukin 28B rs12979860 single nucleotide polymorphism (IL28B) and liver fibrosis stage on RGT in HIV/HCV-coinfected patients.

Methods:

430 HIV/HCV-coinfected patients treated with PEGIFN+RBV were included in this multinational, retrospective analysis. Advanced liver fibrosis was defined as either METAVIR F3/F4 or liver stiffness > 9.5kPa.

Results:

In patients with HCV-GT1/4 without RVR (GT1/4-noRVR), higher sustained virologic response (SVR) rates were observed in patients with extended treatment duration (48 weeks: 35% vs. 72 weeks: 60%; p = 0.008). In GT1/4-noRVR patients without advanced liver fibrosis (48 weeks: 46% vs. 72 weeks: 61%; p = 0.176), or with IL28B C/C (48 weeks: 48% vs. 72 weeks: 69%; p = 0.207), SVR rates did not vary significantly throughout the treatment duration subgroups. In contrast, in patients with advanced liver fibrosis (48 weeks: 11% vs. 72 weeks: 46%; p = 0.031), or IL28B non-C/C (48 weeks: 28% vs. 72 weeks: 56%; p = 0.011), extended treatment duration was associated with substantially higher SVR rates. HCV-GT2/3 patients with RVR (GT2/3-RVR) with shortened treatment duration (24 weeks) displayed SVR rates ranging from 83% to 100%, regardless of IL28B and liver fibrosis stage.

Conclusions:

Our study confirms the concept of RGT in HIV/HCV coinfection and supports the extension of therapy duration to 72 weeks for patients with GT1/4-noRVR, especially in patients with IL28B non-C/C or advanced liver fibrosis. In patients with GT2/3-RVR, the shortening of treatment duration to 24 weeks is associated with excellent SVR rates, regardless of IL28B and liver fibrosis stage.