Hepatitis C Virus (HCV) Quasispecies Complexity and Selection in HCV/HIV-Coinfected Subjects Treated with Interferon-Based Regimens

University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0595, USA.
The Journal of Infectious Diseases (Impact Factor: 6). 03/2010; 201(5):712-9. DOI: 10.1086/650490
Source: PubMed


Coinfection with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) has emerged as a major cause of morbidity and mortality due to liver disease. Interferon-based therapy response rates have been disappointingly low. Baseline HCV complexity and the relationship between complexity and viral kinetic parameters has not been well described in HCV/HIV-coinfected subjects.
A subset of patients enrolled in the AIDS Clinical Trials Group 5071 trial underwent sampling to evaluate viral kinetics and changes in HCV complexity. Early kinetic parameters, baseline complexity, and treatment outcomes--including rapid viral response (RVR), early viral response (EVR), and sustained viral response (SVR)--were evaluated. HCV-monoinfected subjects were matched to HCV/HIV-coinfected subjects.
Baseline complexity was determined in 108 HCV/HIV-coinfected subjects and in 13 HCV-monoinfected control subjects. Quasispecies complexity was a mean of 2.24 bands for HCV/HIV-coinfected subjects and a mean of 1.90 bands for HCV-monoinfected subjects (P = .14). Lower baseline complexity was associated with EVR (P = .04) and approached statistical significance for SVR. In patients who underwent viral kinetic modeling, a decrease in complexity was associated with RVR (P = .03) and was independent of the correlation between first-phase viral decline efficiency and RVR.
Baseline HCV complexity is an independent predictor of EVR in HCV/HIV-coinfected subjects. A decrease in complexity occurs by 4 weeks after the initiation of interferon-based therapy and is associated with RVR. These findings may enhance the predictive modeling of treatment outcome in HCV/HIV-coinfected patients.

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    • "The best predictors of treatment outcome are virologic response kinetics, including rapid viral response (RVR), defined as HCV viral load below the level of detectability 4 weeks after treatment initiation, early viral response (EVR), defined as undetectable HCV load or a 2 log drop from baseline 12 weeks after therapy initiation, and SVR, defined as undetectable HCV load 24 weeks after therapy completion [81]. While undetectable HCV RNA at week 4 is the best predictor of SVR in co-infected patients, baseline serum HCV RNA is an independent predictor of SVR in HCV genotype 1 patients [82]. "
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