Telaprevir in the Treatment of Acute Hepatitis C Virus Infection in HIV-Infected Men

(See the Editorial Commentary by Zeremski et al on pages 880–2.) Hepatitis C virus (HCV) chronically infects an estimated 5.2 million people in the United States and 170 million people worldwide [1]. However, as most initial (“acute”) infections are completely asymptomatic, newly infected people are rarely identified. The importance of finding these newly HCV-infected people during the acute phase was made clear in the seminal paper by Jaeckel et al [2] that showed a nearly 100% sustained virologic response (SVR) rate using just 24 weeks of interferon alone, an SVR rate many times higher than that of chronically infected patients at that time, and with just half the duration of interferon [3]. We are now faced with an entirely new group of patients who are becoming HCV infected in the international epidemic of sexually transmitted HCV infection among human immunodeficiency virus (HIV)–infected men who have sex with men (MSM). Published cure rates after treatment of acute HCV in these men, using pegylated interferon (peg-IFN) plus ribavirin (RBV) for 24–48 weeks’ duration, are not as good as those of Jaeckel et al [2], ranging from 53% to 83% [4–15], but are clearly better than the 27%–40% success rates in treatment of chronic HCV in HIV-infected men [16, 17]. Still, even with 48 weeks of treatment in many of these studies of acute HCV, fewer than two-thirds of patients achieved SVR, leaving a large proportion of these men uncured, with the possibility of experiencing rapidly advancing liver disease [18–21] and of infecting others and further propagating the epidemic. With the commercial availability of telaprevir (TVR) in the United States, we hypothesized that its potent activity against genotype 1 HCV would allow us to further shorten the treatment period while also improving the SVR rate. We therefore undertook a study of a 12-week treatment course with a combination of TVR, peg-IFN, and RBV in HIV-infected MSM with newly acquired genotype 1 HCV.