Optimizing ribavirin dose in HIV/hepatitis C (HCV) co‐infected individuals treated for HCV

In: Journal of the International AIDS Society, Band 15, Heft S4, S. 1-1

Abstract

Hepatitis C (HCV) and HIV share common transmission pathways and the acquisition of both viruses are relatively common. Concurrent treatment for HCV with highly active anti‐retroviral therapy (HAART) should be considered in HIV co‐infected individuals to decrease the progression of liver damage. Adverse effects and less satisfactory treatment outcomes are often concerns when treating co‐infected individuals. Although, direct acting antivirals (DAAs) may increase SVR, they may not be possible because of drug‐drug interactions. he objective of this study is to investigate the difference in response rates of HCV treatment in HIV co‐infected inmates with varying doses of ribavirin. Retrospective medical chart reviews of 52 HCV/HIV co‐infected inmates who underwent HCV therapy between 2003 and 2010. All received standard doses of pegylated interferon alpha 2a or 2b and 800–1600 mg of ribavirin depending on weight. The recommended dosage for genotypes 2 and 3 is 800 mg/day. For other genotypes, if weight is<75 kg, the recommended ribavirin dose is 1000 mg/day or 1200 mg/day if>75 kg. Efficacy was defined as attaining sustained virological response (SVR) six months post treatment. Univariate analyses was performed using SPSS‐18; Chi‐square test with p‐value<0.05 was defined significant. 52 co‐infected (3 females & 49 males) were identified. Mean age was 40±7 years. Caucasians accounted for 84.6%; First Nations for 13.5% and Asians 1.9%. 36 were concurrently on HAART. The genotype distribution was: geno 1, 66.0%; geno 2, 7.5%; geno 3, 26.4%. SVR by ribavirin dosage ratio (actual dosage/recommended dosage):=1.0; 41.2% (14/34),>1.0; 58.8% (20/34). Doses greater than 1.5 times were associated with higher adverse events and lower SVR. Suboptimal doses of weight‐based ribavirin may be contributing to a lower treatment response in HCV/HIV co‐infectants. In our experience, the optimal dose of ribavirin is between 1 and 1.2 times the current recommended dose. We recommend that ribavirin dose be individualized in co‐infected in order to enhance the likelihood of achieving SVR. Dual therapy is more practical in many of our population because of chaotic lifestyle. Therefore optimizing the ribavirin dose should be initially undertaken.