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Response-guided therapy for chronic hepatitis C virus infection in patients coinfected with HIV: a pilot trial
Eva Van den Eynde1, Manuel Crespo, Juan I Esteban
1Infectious Diseases Department, Vall d'Hebron Hospital, Autonomous University of Barcelona, Spain.
Insights
Response-guided therapy for chronic hepatitis C virus (HCV) in HIV-coinfected patients is feasible. This approach optimizes treatment outcomes by individualizing therapy duration based on virologic response, showing promise for better patient management.
Area of Science:
- Hepatology
- Infectious Diseases
- Virology
Background:
- Chronic hepatitis C virus (HCV) infection in coinfected human immunodeficiency virus (HIV) patients presents unique treatment challenges.
- Evaluating response-guided therapy (RGT) is crucial for optimizing treatment efficacy in this population.
- Tertiary care hospital settings provide a platform for studying complex coinfections.
Purpose of the Study:
- To assess the feasibility of a response-guided therapy (RGT) for chronic hepatitis C virus (HCV) infection.
- To evaluate the efficacy of RGT in patients coinfected with human immunodeficiency virus (HIV).
- To individualize treatment duration based on patient virologic response.
Main Methods:
- Sixty patients coinfected with HIV and HCV were enrolled.
- Treatment involved pegylated interferon alfa-2b and weight-based ribavirin.
- Therapy duration was individualized based on week 4 and week 12 virologic response.
Main Results:
- Overall, 55% of patients achieved a sustained virologic response (SVR).
- SVR rates varied significantly by HCV genotype (Genotype 3: 79%, Genotype 1: 44%, Genotype 4: 27%).
- A high relapse rate (46%) was observed in patients with genotypes 1 or 4 treated for 48 weeks.
Conclusions:
- Response-guided therapy is a feasible strategy for managing HCV in HIV-coinfected patients.
- Individualizing treatment duration based on virologic response can optimize patient outcomes.
- Further research is needed to refine RGT protocols for different HCV genotypes in coinfected populations.
Background:
To study the feasibility of a response-guided therapy for chronic hepatitis C virus (HCV) infection in patients coinfected with human immunodeficiency virus (HIV) in a tertiary care hospital.
Methods:
Treatment duration was individualized on the basis of week 4 and week 12 virologic response. Sixty patients were enrolled and received pegylated interferon alfa-2b (1.5 microg/kg per week) plus weight-based ribavirin (800-1400 mg/day). Patients who achieved a rapid virologic response, defined as viral load <50 IU/mL at treatment week 4, completed 24 weeks of therapy. Patients who did not achieve a rapid virologic response were reassessed at treatment week 12. Patients with a complete early virologic response, defined as an HCV RNA level <600 IU/mL, were treated for 48 weeks. Patients with a partial response, defined as a decrease in the viral load > or = 2 log10 and an HCV RNA level > or = 600 IU/mL, who attained an undetectable viral load at week 24 were treated for 60 weeks. The primary efficacy end point was sustained virologic response, defined as HCV RNA <50 IU/mL, 24 weeks after the end of treatment.
Results:
Overall, 33 (55%) of 60 patients achieved a sustained virologic response: 11 (44%) of 25 patients with HCV genotype 1, 3 (27%) of 11 patients with genotype 4, and 19 (79%) of 24 patients with genotype 3. One-third of patients showed a rapid virologic response. Of patients with genotype 1, there was a rapid virologic response in 4 (16%) of 25; with genotype 4, in 1 (9%) of 11; and with genotype 3, in 14 (58%) of 24. Of the 19 patients with a rapid virologic response, 17 (89.5%) eradicated the virus after 24 weeks of therapy. The rate of sustained virologic response was significantly higher among patients with genotype 3 and low pretreatment HCV RNA levels. A high relapse rate (46%) after 48 weeks of therapy occurred among patients infected with genotypes 1 or 4 who first achieved undetectable viral load at treatment week 12.
Conclusion:
A response-guide therapy is feasible and may be useful to optimize the individual outcome of HCV treatment in patients coinfected with HIV.
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