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CROI 2013: Adding telaprevir improves response & shortens treatment of acute HCV in HIV-positive MSM

Acute Hepatitis C is an important health issue for HIV+ MSM however little is known about the optimal duration of treatment in this population. In an oral presentation today Dr. Daniel Fierer, from Mount Sinai Hospital in NYC, reviewed the current state of knowledge of treatment of acute Hepatitis C and presented data from his clinic on novel treatment regimens.

Past studies have shown that treatment of acute Hepatitis C with pegylated interferon (pIFN) and ribavirin (RBV) for 24-48 weeks results in an average sustained virologic of response (SVR) of 63%. Dr. Fierer reported data from a consecutive enrollment open label study among sexually active MSM with acute hepatitis C infection, to determine if the addition of telaprevir (TVR) to pIFN+RBV would shorten the treatment duration to 12 weeks and increase the SVR rate in acute genotype 1 HCV infection in HIV+ men.

Patients were included in this study if they had a 3-fold elevation in ALT and detectible hepatitis C viremia or antibody. Treatment was with TVR 750 mg/8 hr, pIFN-α 180 μg/wk and weight-based RBV for 12 weeks. Since telaprevir cannot be used with certain antiretroviral regimens, participants on established ARVs were required to be on, or switch to, tenofovir/emtricitabine plus efavirenz (with TVR dose adjustment), atazanavir/ritonavir, or raltegravir.

Eighteen men fulfilled criteria and were eligible to initiate triple therapy with TVR/pIFN/RBV. Fifteen (83%) of these men treated with triple HCV therapy achieved SVR 4 with median time to VL <5 being week 2.
Although this is a small study, the 83% SVR 4 is promising compared to historical rates of 62% in a comparator group treated for longer periods with pIFN+RBV. In addition, this small study suggests that addition of telaprevir may allow shortening established treatment duration from 24-48 weeks to 12 weeks.

Fierer D. Telaprevir for acute hepatitis C virus in HIV+ men both shortens treatment and improves outcome. Presented March 6, 2013 at the 20th CROI, Atlanta, GA. Oral Abstract # 156LB.

Source: Reporting from Atlanta for PRN News: Anita Radix MD, MPH