Rates and predictors of response to anti‐viral treatment for hepatitis C virus in HIV / HCV co‐infection in a nationwide study of 619 patients

Summary Background The effectiveness of anti‐viral treatment for hepatitis C virus ( HCV ) in HIV / HCV co‐infected patients in ‘real world’, clinical practice is unclear. Aims To determine the rates and predictors of sustained virological response ( SVR ) to anti‐viral treatment for HCV with pegylated interferon (PEG‐IFN) and ribavirin in HIV / HCV co‐infected patients. Methods We identified all HIV / HCV co‐infected patients who received anti‐viral treatment with PEG‐IFN and ribavirin in the Veterans Affairs healthcare system nationally between 2002 and 2009 ( n  = 665). Results Sustained virological response was achieved in 21.6% overall, 16.7% among patients with genotype 1 HCV ( n  = 491) and 44% among patients with genotype 2 or 3 HCV ( n  = 116). Among genotype 1‐infected patients, characteristics that were negatively associated with SVR independently included baseline HCV viral load >2 million IU/mL [adjusted odds ratio ( AOR ) 0.41, 95% CI 0.2–0.7], Black race [ AOR 0.56 (0.3–0.96)], diabetes [ AOR 0.42 (0.2–0.9)], baseline anaemia [ AOR 0.42 (0.2–0.97)], serum aspartate aminotransferase/alanine aminotransferase ratio ≥1.2 [ AOR 0.48 (0.2–0.97)] and use of zidovudine [ AOR 0.41 (0.2–0.9)]; characteristics positively associated with SVR included a starting dose of ribavirin ≥1000–1200 mg/day [ AOR 2.0 (1.1–3.7)] and erythropoietin use during treatment [ AOR 2.9 (1.6–5.0)]. Among genotype 2 or 3 infected patients, only erythropoietin use was an independent predictor of SVR [ AOR 3.1 (1.2–7.8)], while a starting dose of ribavirin >800 mg/day was not associated with SVR . Conclusions Sustained virological response rates achieved with PEG‐IFN and ribavirin in HIV / HCV co‐infected patients are low in clinical practice. The use of erythropoietin was the most important, modifiable factor associated with SVR .