ANRS HC20 Effectiveness of an Optimized Anti HCV PegIFN-alpha2a + Ribavirin on Sustained Virological Response in Patients With HCV Genotype 1 and 4 Non Responders and Co-infected With HIV

In patients HIV infected, the success rate do not exceed 20% in genotype 1 or 4 patients. In case of treatment failure , patients are rarely re-treated, and liver fibrosis progresses rapidly. The new molecules are not yet available for patients co-infected with HIV, and patients having already undergone a first treatment will likely be among the last to be included in trials evaluating the effectiveness of these treatments.

However, recent studies show that it is possible to propose a new treatment "optimized" to these patients in the hope to obtain better success rate. Provide antiretroviral treatment, use of high doses of Peg-interferon and ribavrine, and supporting patients.

Inclusion criteria

• Age over 18 years
• Weight 85 kg below the pre-inclusion visit.
• Documented HIV infection (HIV positive)
• HCV infection documented by a positive PCR
• HCV Genotype 1 or 4
• Compensated liver disease (Child-Pugh below/equal to 6)
• Lymphocytes CD4 above 200/mm3
• Patient not answering a treatment for hepatitis C.
• Patient not covered by dual by Peg-IFN + riba for at least three months (wash out)

Exclusion criteria

• Co-infection with HBV (HBsAg positive)
• Neutropenia below 1000/mm3
• Thrombocytopenia below 90000/mm3 or thrombocytosis over 500 000/mm3.
• Hemoglobin below 11 g / dL (men and women)
• Arguments radiological (ultrasound, CT or MRI) of hepatocellular carcinoma cell
• Antiretroviral containing didanosine (ddI) and stavudine (d4T) and zidovudine (AZT) and abacavir (ABC).