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Predictive factors for achieving sustained virological response under hepatitis C infection therapy
J. Portu, S. San Miguel, G. Arroita, I. Frago, P. Tarabini, M. Aldamiz
Txagorritxu Hospital, Vitoria, Spain
Background: Our aim is to determine predictive factors of response to treatment out of clinical trials and the influence of psychiatric comorbidities in the result of HCV treatment in a population with antecedents of drug addiction mainly
Methods: Patients with HIV/HCV coinfection treated with peg-IFN and ribavirin. The following factors are analyzed: age, sex, CDC stage, CD4, antirretroviral therapy, HCV genotype and viral load, grade of liver fibrosis measured by FibroScan and psychiatric comorbidity according to code CIE-10.
Results: Of 114 HIV/HCV coinfected patients, 97,3% had been injecting drug users, 76% were men, mean age was 39,7 years old (21-52 years); 73% were under antirretroviral therapy and the mean CD4 was 537,8; the most frequent CDC stages were A-2 (33,3%), A-3 (20%) and C-3 (17,3%); 58,4% had genotype 1 or 4 and 41,2% had genotype 2 or 3 and 28,1% had psychiatric comorbidity (8,3% schizophrenia, schizotypal and delusional disorders; 37,5% affective disorders; 16,7% neurotic disorders and 37,5% disorders of adult personality and behaviour). Fibrosis measured by elastography was F1 in 37,3%, F2 in 11,9%, F3 in 19,4% and F4 in 31,3%.Sustained virological response (SVR) was achieved in 40,8%. Genotype 2 and 3 (p< 0,001), fibrosis grade lower than F2 (p=0,002) and lack of psychiatric comorbidity (p=0,026) are significantly associated with more SVR.
Conclusions: Besides HCV genotype and grade of fibrosis, the presence of psychiatric comorbidity in a population with antecedents of drug addiction is a predictive factor of lower response.
It is necessary to form multidisciplinary teams in the treatment of HCV in order to achieve similar response rates than the population without problems of psychiatric comorbidity and/or drug addiction.
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