Page 55 - The Flying Publisher Guide to Hepatitis C Treatment

Antiviral therapy in non-responders, relapsers and special populations | 55

African Americans
CHC in African Americans shows a more favorable course
characterized by lower serum ALT level, less inflammation on
biopsies, less trend to progress to cirrhosis, but a greater than
threefold higher risk of HCC as compared with whites.
African Americans have lower SVR when treated with
PegIFN/RBV (Jeffers 2004). In WIN-R trial, African Americans
have a significant higher SVR when treated with PegIFN alfa-2b
and weight-based RBV doses ranging between 800 and 1400
mg/day as compared with fixed RBV dose of 800 mg/day (21% vs.
10%, p=0.004) (Jacobson 2004). Despite advances in HCV therapy,
African Americans have decreased SVR with PegIFN/RBV, even
when optimized dosing is used and this may be explained partly
by the high distribution of unfavorable genetic predictors of SVR
(such as genotype 1 (McHutchison 2000) and unfavorable allele
CT and TT of IL28B (Ge 2009) as compared with other ethnic
groups (see also chapter 1).

HIV-HCV coinfection
Because of shared risk factors, HCV co-infection is common (10-
40%) among HIV-infected persons. HIV infection accelerates the
progression to advanced fibrosis and cirrhosis and increases the
risk for liver-related complications, including hepatocellular
carcinoma compared with HCV monoinfected patients. As a
result of the effectiveness of highly active antiretroviral
(HAART) therapy, the longevity of HIV-infected patients has
increased and HCV infection emerged as a major cause of
morbidity and mortality among this population.
A significant proportion of HIV-HCV coinfected patients (with
stable HIV infection, no AIDS, mean CD4 counts greater than
6
400x10 /L and compensated liver disease) can be treated
successfully with PegIFN/RBV. SVR to PegIFN/RBV is lower in
HIV-HCV coinfected patients, ranging between 26% and 44%
(Torriani 2004, Carrat 2004).