Adding telaprevir to pegylated interferon and ribavirin for the treatment of acute genotype 1 hepatitis C infection in HIV-positive men reduced the duration of hepatitis C therapy by half for most patients and improved sustained virologic response rates, according to new data.
“There is an international epidemic of hepatitis C virus infection among HIV-infected men who have sex with men,” Daniel S. Fierer, MD, of Mount Sinai School of Medicine, and colleagues wrote in Clinical Infectious Diseases. “Sustained virological response (SVR) rates with pegylated interferon and ribavirin treatment are higher in these men during acute HCV than during chronic HCV, but treatment is still lengthy and SVR rates are suboptimal.”
Daniel S. Fierer
In a small pilot study, 19 HIV-infected MSM were treated for acute HCV at Mount Sinai Medical Center with telaprevir (Incivek, Vertex Pharmaceuticals) combined with pegylated interferon (PEG-IFN) and ribavirin for 12 weeks. A comparison group of 48 MSM treated before the availability of telaprevir or ineligible for the drug was given the standard dual therapy of PEG-IFN plus ribavirin.
At 12 weeks, 84% of patients in the telaprevir treatment group achieved SVR compared with 63% of those who received standard care. Of those who achieved SVR, the median time to undetectable viral load was 2 weeks in the telaprevir group vs. 4 weeks in the comparison group; 94% vs. 53% had undetectable viral loads at 4 weeks. Most patients who received telaprevir with PEG-IFN plus ribavirin achieved SVR within 12 weeks, and the telaprevir group experienced no relapses.
“This study, the first to test a direct-acting anti-HCV drug for acute HCV, is proof of principle that short courses for acute HCV using these soon-to-be-available new drugs should be evaluated quickly,” the researchers wrote. “But we believe that strong efforts should be made now to find and treat the men in this expanding sexually transmitted HCV epidemic using the currently available treatments including [telaprevir], rather than waiting for these new treatments, echoing the call for ‘test and treat’ in HIV and similarly in HCV treatment in injection drug users, to try to both prevent liver disease in these men and prevent further HCV infections and control this epidemic.”
Disclosure: The researchers report no relevant financial disclosures.