The 2-log cutoff
“We are withholding effective treatment from people just because we’re concerned about the money,” said Christoph Boesecke, MD, of Bonn (Germany) University Hospital, who was the lead investigator in the study that found low spontaneous clearance rates with HIV coinfection.
Almost all the 465 subjects were on combination antiretroviral HIV therapy. Most had HCV genotype 1, but there were also type 3 and 4 cases. The investigators followed their subjects for at least a year after HCV infection. Just 55 (11.8%) cleared the infection on their own.
“Almost 90% of acutely infected patients face a chronic course. ... DAA drug labels, as well as clinical guidelines, need to be amended to allow usage of DAA during the acute phase of HCV infection in a high-risk population,” Dr. Boesecke and his team concluded.
Clearance was harbingered by a 2-log decline in HCV RNA by week 4. The 2-log drop cutoff is “the best predictor [we have] ... to identify patients” for early treatment. “There may be some patients you overtreat, but we have to keep in mind that we are not causing any harms with DAAs; maybe harms in terms of money, but not in terms of toxicity,” he said.
The message is beginning to get out. New European AIDS Clinical Society guidelines recommend DAA treatment for patients with HIV who don’t have a 2-log drop after a month.