Background/Aims: Of the 35 million human immunodeficiency virus (HIV)-positive patients worldwide, 10-40% are coinfected with chronic hepatitis C virus (HCV). Compared to HCV-monoinfected patients, those coinfected experience decreased spontaneous HCV clearance, accelerated liver fibrosis, and a decreased response to anti-HCV therapy. We conducted a meta-analysis to estimate the efficacy of treating acute HCV in HIV-positive patients with peginterferon and ribavirin combination therapy. Methods: Two authors independently searched MEDLINE and EMBASE (2014) for English articles, and reviewed bibliographies and abstracts from major liver and HIV conferences (2011-2013). Original studies featuring at least 10 treatment-naive, HIV-positive adults infected with acute HCV and treated with peginterferon and ribavirin were included. Analyses were calculated using a random-effects model. Heterogeneity was assessed using the Cochrane Q test (p < 0.05) and the I2 statistic (>50%). Results: From 12 studies (450 patients), the pooled sustained virological response (SVR) was 71.4% (95% CI 64.7-77.4; Q statistic = 22.20, p = 0.023, I2 = 50.44). The rapid virological response (RVR; 7 studies, 196 patients) was 47.4% (95% CI 40.6-54.7), and the early virological response (EVR; 9 studies, 283 patients) was 82.8% (95% CI 67.0-92.0). The probability of an SVR was 93.1% (95% CI 84.9-97.0) in those who obtained an RVR (6 studies, 82 patients) and 85.9% (95% CI 78.7-91.0) if an EVR (7 studies, 168 patients) was reached. Conclusion: Peginterferon with ribavirin is an effective option for treating acute HCV in HIV-positive patients, especially if they achieve an RVR or an EVR.

World Health Organization: Global update on the health sector response to HIV, 2014. 2014.
Anderson KB, Guest JL, Rimland D: Hepatitis C virus coinfection increases mortality in HIV-infected patients in the highly active antiretroviral therapy era: data from the HIV Atlanta VA cohort study. Clin Infect Dis 2004;39:1507-1513.
Hullegie SJ, Arends JE, Rijnders BJ, Irving WL, Salmon D, Prins M, Wensing AM, Klenerman P, Leblebicioglu H, Boesecke C, Rockstroh JK, Hoepelman AI: Current knowledge and future perspectives on acute hepatitis C infection. Clin Microbiol Infect 2015;21:797.e9-797.e17.
Vickerman P, Martin NK, Roy A, Beattie T, Jarlais DD, Strathdee S, Wiessing L, Hickman M; EMCDDA Collaborative Group: Is the HCV-HIV co-infection prevalence amongst injecting drug users a marker for the level of sexual and injection related HIV transmission? Drug Alcohol Depend 2013;132:172-181.
Alter MJ: Epidemiology of viral hepatitis and HIV co-infection. J Hepatol 2006;44:S6-S9.
Schnuriger A, Dominguez S, Guiguet M, Harfouch S, Samri A, Ouazene Z, Slama L, Simon A, Valantin MA, Thibault V, Autran B; ANRS HC EP21 study group: Acute hepatitis C in HIV-infected patients: rare spontaneous clearance correlates with weak memory CD4 T-cell responses to hepatitis C virus. AIDS 2009;23:2079-2089.
Alter MJ, Margolis HS, Krawczynski K, Judson FN, Mares A, Alexander WJ, Hu PY, Miller JK, Gerber MA, Sampliner RE, et al: The natural history of community-acquired hepatitis C in the United States. The Sentinel Counties Chronic Non-A, Non-B Hepatitis Study Team. N Engl J Med 1992;327:1899-1905.
Micallef JM, Kaldor JM, Dore GJ: Spontaneous viral clearance following acute hepatitis C infection: a systematic review of longitudinal studies. J Viral Hepat 2006;13:34-41.
Thomas DL, Astemborski J, Rai RM, Anania FA, Schaeffer M, Galai N, Nolt K, Nelson KE, Strathdee SA, Johnson L, Laeyendecker O, Boitnott J, Wilson LE, Vlahov D: The natural history of hepatitis C virus infection: host, viral, and environmental factors. JAMA 2000;284:450-456.
Villano SA, Vlahov D, Nelson KE, Cohn S, Thomas DL: Persistence of viremia and the importance of long-term follow-up after acute hepatitis C infection. Hepatology 1999;29:908-914.
Measuring quality of life in women with osteoporosis. Osteoporosis Quality of Life Study Group. Osteoporos Int 1997;7:478-487.
Fierer DS, Mullen MP, Dieterich DT, Isabel Fiel M, Branch AD: Early-onset liver fibrosis due to primary hepatitis C virus infection is higher over time in HIV-infected men. Clin Infect Dis 2012;55:887-888; author reply 888-889.
Vogel M, Page E, Boesecke C, Reiberger T, Schwarze-Zander C, Mauss S, Baumgarten A, Wasmuth JC, Nelson M, Rockstroh JK; European ATNSG: Liver fibrosis progression after acute hepatitis C virus infection in HIV-positive individuals. Clin Infect Dis 2012;54:556-559.
Iorio A, Marchesini E, Awad T, Gluud LL: Antiviral treatment for chronic hepatitis C in patients with human immunodeficiency virus. Cochrane Database Syst Rev 2010, p CD004888.
Simin M, Brok J, Stimac D, Gluud C, Gluud LL: Cochrane systematic review: pegylated interferon plus ribavirin vs. Interferon plus ribavirin for chronic hepatitis C. Aliment Pharmacol Ther 2007;25:1153-1162.
Ioannou GN, Scott JD, Yang Y, Green PK, Beste LA: Rates and predictors of response to anti-viral treatment for hepatitis C virus in HIV/HCV co-infection in a nationwide study of 619 patients. Aliment Pharmacol Ther 2013;38:1373-1384.
Sulkowski M, Pol S, Mallolas J, Fainboim H, Cooper C, Slim J, Rivero A, Mak C, Thompson S, Howe AY, Wenning L, Sklar P, Wahl J, Greaves W; PO5411 Study Investigators: Boceprevir versus placebo with pegylated interferon alfa-2b and ribavirin for treatment of hepatitis c virus genotype 1 in patients with HIV: a randomised, double-blind, controlled phase 2 trial. Lancet Infect Dis 2013;13:597-605.
Sulkowski MS, Naggie S, Lalezari J, Fessel WJ, Mounzer K, Shuhart M, Luetkemeyer AF, Asmuth D, Gaggar A, Ni L, Svarovskaia E, Brainard DM, Symonds WT, Subramanian GM, McHutchison JG, Rodriguez-Torres M, Dieterich D; PHOTON-1 Investigators: Sofosbuvir and ribavirin for hepatitis C in patients with HIV coinfection. JAMA 2014;312:353-361.
Sulkowski MS, Sherman KE, Dieterich DT, Bsharat M, Mahnke L, Rockstroh JK, Gharakhanian S, McCallister S, Henshaw J, Girard PM, Adiwijaya B, Garg V, Rubin RA, Adda N, Soriano V: Combination therapy with telaprevir for chronic hepatitis C virus genotype 1 infection in patients with HIV: a randomized trial. Ann Intern Med 2013;159:86-96.
Hill A, Khoo S, Fortunak J, Simmons B, Ford N: Minimum costs for producing hepatitis C direct-acting antivirals for use in large-scale treatment access programs in developing countries. Clin Infect Dis 2014;58:928-936.
Calleri G, Cariti G, Gaiottino F, De Rosa FG, Bargiacchi O, Audagnotto S, Quaglia S, De Blasi T, Romano P, Traverso A, Leo G, Carbone R, Del Mastro B, Tinelli M, Caramello P, Di Perri G: A short course of pegylated interferon-alpha in acute HCV hepatitis. J Viral Hep 2007;14:116-121.
Corey KE, Mendez-Navarro J, Gorospe EC, Zheng H, Chung RT: Early treatment improves outcomes in acute hepatitis C virus infection: a meta-analysis. J Viral Hep 2010;17:201-207.
Jaeckel E, Cornberg M, Wedemeyer H, Santantonio T, Mayer J, Zankel M, Pastore G, Dietrich M, Trautwein C, Manns MP; German Acute Hepatitis C Therapy Group: Treatment of acute hepatitis C with interferon alfa-2b. N Engl J Med 2001;345:1452-1457.
Sharma SA, Feld JJ: Acute hepatitis C: management in the rapidly evolving world of HCV. Curr Gastroenterol Rep 2014;16:371.
European AIDS Treatment Network (NEAT) Acute Hepatitis C Infection Panel: Acute hepatitis C in HIV-infected individuals: recommendations from the European AIDS Treatment Network (NEAT) consensus conference. AIDS 2011;25:399-409.
Grebely J, Hellard M, Applegate T, Petoumenos K, Yeung B, Feld JJ, Rawlinson W, Lloyd AR, George J, Kaldor JM, Dore GJ, Matthews GV; ATAHC Study Group: Virological responses during treatment for recent hepatitis C virus: potential benefit for ribavirin use in HCV/HIV co-infection. AIDS 2012;26:1653-1661.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009;339:b2700.
Higgins J: Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0. Chichester, Wiley, 2011.
Harbord R, Higgins J: Meta-regression in Stata. Stata J 2008;8:493-519.
Thompson SG, Higgins JP: How should meta-regression analyses be undertaken and interpreted? Stat Med 2002;21:1559-1573.
Sterne JAC: Meta-Analysis in Stata: an Updated Collection from the Stata Journal, ed 1. College Station, Strata Press, 2009.
Sterne JAC, Harris RJ, Harbord RM, Steichen TJ: What meta-analysis features are available in Stata? 2013.
Abdelrahman T, Bird E, Karayiannis P, Main J, Thomson E: Viral relapse is associated with the emergence of new viral strains following treatment in an HIV-positive cohort infected with acute HCV. HIV Med 2012;13(suppl 1):40-41.
Arends JE, van Assen S, Stek CJ, Wensing AM, Fransen JH, Schellens IM, Spijkers SN, Mudrikova T, van Baarle D, Sprenger HG, Hoepelman AI: Pegylated interferon-alpha monotherapy leads to low response rates in HIV-infected patients with acute hepatitis C. Antivir Ther 2011;16:979-988.
Hafkin J, Kikuchi M, Van Seggelen W, Valiga ME, Nunes F, Amorosa V, Mounzer K, Kaplan DE, Frank I, Tebas P, Reddy KR, Aytaman A, Branch AD, Fierer DS, Chang KM: A comparison of the clinical and immunological characteristics in patients with acute hepatitis C with and without HIV-coinfection. Gastroenterology 2012;142(suppl 1):968.
Obermeier M, Ingiliz P, Weitner L, Cordes C, Moll A, Hintsche B, Schlote F, Koeppe S, Christensen S, Mayr C, Baumgarten A: Acute hepatitis C in persons infected with the human immunodeficiency virus (HIV): the ‘real-life setting' proves the concept. Eur J Med Res 2011;16:237-242.
Serpaggi J, Chaix ML, Batisse D, Dupont C, Vallet-Pichard A, Fontaine H, Viard JP, Piketty C, Rouveix E, Rouzioux C, Weiss L, Pol S: Sexually transmitted acute infection with a clustered genotype 4 hepatitis C virus in HIV-1-infected men and inefficacy of early antiviral therapy. AIDS 2006;20:233-240.
Gilleece YC, Browne RE, Asboe D, Atkins M, Mandalia S, Bower M, Gazzard BG, Nelson MR: Transmission of hepatitis C virus among HIV-positive homosexual men and response to a 24-week course of pegylated interferon and ribavirin. J Acquir Immune Defic Syndr 2005;40:41-46.
Dominguez S, Ghosn J, Valantin MA, Schruniger A, Simon A, Bonnard P, Caumes E, Pialoux G, Benhamou Y, Thibault V, Katlama C: Efficacy of early treatment of acute hepatitis C infection with pegylated interferon and ribavirin in HIV-infected patients. Aids 2006;20:1157-1161.
Dorward J, Garrett N, Scott D, Buckland M, Orkin C, Baily G: Successful treatment of acute hepatitis C virus in HIV positive patients using the European AIDS Treatment Network guidelines for treatment duration. J Clin Virol 2011;52:367-369.
Halperin D, Hindocha S, Main J, Thomson E: Injecting drug use is associated with treatment failure in HIV-positive men infected with acute hepatitis C. HIV Med 2013;14 (suppl 2):69.
Laguno M, Martinez-Rebollar M, Perez I, Costa J, Larrousse M, Calvo M, Lonca M, Munoz A, Gonzalez-Cordon A, Blanco JL, Martinez E, Gatell JM, Mallolas J: Low rate of sustained virological response in an outbreak of acute hepatitis C in HIV-infected patients. AIDS Res Hum Retroviruses 2012;28:1294-1300.
Lambers FA, Brinkman K, Schinkel J, Spijkerman IJ, Molenkamp R, Coutinho RA, Prins M, van der Meer JT; MOSAIC Study Group: Treatment of acute hepatitis C virus infection in HIV-infected MSM: the effect of treatment duration. AIDS 2011;25:1333-1336.
Piroth L, Larsen C, Binquet C, Alric L, Auperin I, Chaix ML, Dominguez S, Duval X, Gervais A, Ghosn J, Delarocque-Astagneau E, Pol S; Steering Committee of the HEPAIG Study: Treatment of acute hepatitis C in human immunodeficiency virus-infected patients: the HEPAIG study. Hepatology 2010;52:1915-1921.
Thomson CE, Main J, Karayiannis P, Klenerman P: Intravenous methamphetamine use is associated with lower sustained virological response rates in hiv-positive men who have sex with men infected with acute hepatitis. HIV Med 2011;12(suppl 1):26.
Webster DP, Wojcikiewicz T, Keller M, Castelnovo D, Mistry H, Gilleece Y, Tibble J, Fisher M: Spontaneous clearance and treatment of acute hepatitis C infection in HIV-positive men with 48 weeks of interferon-alpha and ribavirin. Int J STD AIDS 2013;24:179-183.
Dore GJ, Hellard M, Matthews GV, Grebely J, Haber PS, Petoumenos K, Yeung B, Marks P, Van Beek I, McCaughan G, White P, French R, Rawlinson W, Lloyd AR, Kaldor JM: Effective treatment of injecting drug users with recently acquired hepatitis C virus infection. Gastroenterology 2010;138:123-135.e122.
Fierer DS, Dieterich DT, Mullen MP, Branch AD, Uriel AJ, Carriero DC, van Seggelen WO, Hijdra RM, Cassagnol DG; New York Acute Hepatitis C Surveillance Network: Telaprevir in the treatment of acute hepatitis C virus infection in HIV-infected men. Clin Infect Dis 2014;58:873-879.
Panel on Antiretroviral Guidelines for Adults and Adolescents: Guidelines for the use of antiretroviral agents in HIV-1 infected adults and adolescents. Washington, Department of Health and Human Services, 2015.
Naggie S, Cooper C, Saag M, et al: Ledipasvir/sofosbuvir for 12 weeks in patients coinfected with HCV and HIV-1. Conf Retrovir Oppor Infect (CROI). Seattle, 2015.
Sulkowski MS, Eron JJ, Wyles D, Trinh R, Lalezari J, Wang C, Slim J, Bhatti L, Gathe J, Ruane PJ, Elion R, Bredeek F, Brennan R, Blick G, Khatri A, Gibbons K, Hu YB, Fredrick L, Schnell G, Pilot-Matias T, Tripathi R, Da Silva-Tillmann B, McGovern B, Campbell AL, Podsadecki T: Ombitasvir, paritaprevir co-dosed with ritonavir, dasabuvir, and ribavirin for hepatitis C in patients co-infected with HIV-1: a randomized trial. JAMA 2015;313:1223-1231.
European Association for the Study of the Liver: EASL recommendations on treatment of hepatitis C 2015. J Hepatol 2015;63:199-236.
American Association for the Study of Liver Diseases, Infectious Diseases Society of America, International Antiviral Society-USA: Recommendations for testing, managing, and treating hepatitis C. 2015.
Arends JE, Schrover IM, Schaar CG, Mudrikova T, Hoepelman AI: Peginterferon monotherapy for the treatment of acute hepatitis C in HIV-coinfected patients. AIDS 2008;22:1381-1382.
Vogel M, Nattermann J, Baumgarten A, Klausen G, Bieniek B, Schewe K, Jessen H, Boesecke C, Rausch M, Lutz T, Fenske S, Schranzo D, Kummerle T, Schuler C, Theisen A, Mayr C, Seidel T, Rockstroh JK: Pegylated interferon-alpha for the treatment of sexually transmitted acute hepatitis C in HIV-infected individuals. Antivir Ther 2006;11:1097-1101.
Boesecke C, van Assen S, Stellbrink HJ, Baumgarten A, Ingiliz P, Strassburg CP, Schwarze-Zander C, Wasmuth JC, Hoepelman AI, Rockstroh JK, Arends JE: Peginterferon-alfa mono-therapy in the treatment of acute hepatitis C in HIV-infection. J Viral Hepat 2014;21:780-785.
Vogel M, Dominguez S, Bhagani S, Azwa A, Page E, Guiguet M, Valantin MA, Katlama C, Rockstroh JK, Nelson M: Treatment of acute HCV infection in HIV-positive patients: experience from a multicentre European cohort. Antivir Ther 2010;15:267-279.
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