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Treatment intensification with boceprevir in HIV-positive patients with acute HCV-genotype 1 infection at high risk for treatment failure

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Summary

Background

According to current guidelines, the universal use of direct-acting antiviral agents in HIV-positive patients with acute hepatitis C (AHC) is not recommended. We aimed to evaluate the concept of treatment intensification with boceprevir (BOC) in HIV-positive patients with HCV-genotype 1 AHC (HIV/AHC-GT1) at high risk for failure to pegylated interferon/ribavirin therapy (PEGIFN/RBV).

Methods

Nineteen consecutive HIV-positive patients with HIV/AHC-GT1 who underwent antiviral therapy were studied retrospectively.

Patients were treated with PEGIFN/RBV for 24 or 48 weeks, depending on rapid virologic response (RVR; undetectable HCV-RNA at treatment week [W] 4). Patients without complete early virologic response (cEVR; undetectable HCV-RNA at W 12) were offered treatment intensification with BOC at W 12, resulting in 36 weeks of BOC/PEGIFN/RBV triple therapy (total treatment duration: 48 weeks).

Results

Thirty-seven percent (7/19) of patients had an RVR and 74 % (14/19) of patients had a cEVR. BOC was used in four out of five patients who did not achieve cEVR and one patient elected to proceed with PEGIFN/RBV.

Sustained virologic response (SVR; undetectable HCV-RNA 24 weeks after the end of treatment) rates were 100 % (14/14) among patients with cEVR treated with PEGIFN/RBV and 75 % (3/4) among patients without cEVR receiving BOC add-on. The patient without cEVR who preferred to continue with PEGIFN/RBV did not achieve SVR. Thus, the overall SVR rate was 89 % (17/19) in intention to treat analysis.

Conclusions

BOC add-on in selected HIV/AHC-GT1 resulted in a high overall SVR rate. If 2nd generation direct-acting antiviral agents (DAAs) are not available, treatment intensification with BOC can be considered in HIV/AHC-GT1 at high risk for failure to PEGIFN/RBV.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria

    Mattias Mandorfer MD, Sebastian Steiner, Philipp Schwabl MD, Berit A. Payer MD, Michael Trauner MD, Thomas Reiberger MD & Markus Peck-Radosavljevic MD

  2. Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University of Vienna, Vienna, Austria

    Maximilian C. Aichelburg MD & Katharina Grabmeier-Pfistershammer MD

  3. Vienna HIV & Liver Study Group, Vienna, Austria

    Mattias Mandorfer MD, Sebastian Steiner, Philipp Schwabl MD, Berit A. Payer MD, Maximilian C. Aichelburg MD, Katharina Grabmeier-Pfistershammer MD, Thomas Reiberger MD & Markus Peck-Radosavljevic MD

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  1. Mattias Mandorfer MD
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  2. Sebastian Steiner
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  3. Philipp Schwabl MD
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  4. Berit A. Payer MD
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  5. Maximilian C. Aichelburg MD
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  9. Markus Peck-Radosavljevic MD
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Corresponding author

Correspondence to Markus Peck-Radosavljevic MD.

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Conflict of interest

Mattias Mandorfer received grants from the Medical Scientific Fund of the Major of the City of Vienna, honoraria for consulting from Janssen, payments for lectures from Boehringer Ingelheim, Bristol-Myers Squibb, Janssen and Roche, as well as travel support from AbbVie, MSD and Roche.

Philipp Schwabl received payments for lectures from Roche and travel support from Janssen and Roche.

Maximilian C. Aichelburg received honoraria for board membership and consulting from Gilead and MSD and travel support from AbbVie, Gilead and MSD.

Katharina Grabmeier-Pfistershammer received honoraria for consultancy from Gilead, payments for lectures from Bristol-Myers Squibb and ViiV, as well as travel support from Bristol-Myers Squibb, Gilead and GlaxoSmithKline.

Michael Trauner received grants from MSD, honoraria for consulting from AbbVie, Gilead, Janssen and MSD, payments for lectures from Gilead, MSD and Roche as well as travel support from Gilead.

Thomas Reiberger received payments for lectures from Roche, as well as travel support from Gilead, MSD and Roche.

Markus Peck-Radosavljevic received grants from Gilead, MSD and Roche, honoraria for board membership and consulting from AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, Janssen and MSD, as well as payments for lectures from AbbVie, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead, Janssen, MSD and Roche.

For the remaining authors none were declared.

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Mandorfer, M., Steiner, S., Schwabl, P. et al. Treatment intensification with boceprevir in HIV-positive patients with acute HCV-genotype 1 infection at high risk for treatment failure. Wien Klin Wochenschr 128, 414–420 (2016). https://doi.org/10.1007/s00508-015-0912-6

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