Concomitant nevirapine therapy is associated with higher efficacy of pegylated interferon plus ribavirin among HIV/ hepatitis C Virus-Coinfected patients

Objective: To determine the influence of nevirapine (NVP) and lopinavir/ritonavir (LPV/r) on the efficacy of pegylated interferon (peg-IFN) plus ribavirin (RBV) among HIV/HCV-coinfected patients. Methods: All HIV/HCV-coinfected patients who received peg-IFN plus RBV while under a three-drug antiretroviral regimen including tenofovir (TDF) plus lamivudine (3TC) or emtricitabine (FTC) along with NVP or along with LPV/r at twenty hospitals in Spain were included in this retrospective study. Sustained virological response (SVR) rates in both groups were compared. Results: A total of 165 patients were included in the study, 71 (43%) receiving NVP and 94 (57%) LPV/r. Significantly more patients on LPV/r had a baseline HCV-RNA load ≥600000 IU/mL (44% vs. 73%, p=0.001). Forty (56%) individuals included in the NVP group and 35 (37%) in the LPV/r group showed SVR (p=0.015). In the NVP group, 19 (43%) patients carrying genotype 1-4 and 21 (78%) subjects with genotype 2-3 achieved SVR. In the LPV/r group, the corresponding figures were 25% (p=0.04) and 59% (p=0.1). In the subpopulation of individuals with baseline HCV viral load ≥600,000 IU/mL, 18 (58%) of those taking NVP vs. 21 (31%) who were given LPV/r reached SVR (p=0.01). HCV genotype 2-3, adherence to HCV therapy >80% and use of NVP during peg-IFN plus RBV were independently associated with SVR in the multivariate analysis. Conclusions: HIV/HCV-coinfected patients who receive NVP respond better to peg-IFN plus RBV than those individuals receiving LPV/r. Lower HCV viral load due to NVP treatment may account for the former differences.