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Righi E, Londero A, Carnelutti A, Baccarani U, Bassetti M. Impact of new treatment options for hepatitis C virus infection in liver transplantation. World J Gastroenterol 2015; 21:10760-75. [PMID: 26478668 PMCID: PMC4600578 DOI: 10.3748/wjg.v21.i38.10760] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/12/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
Liver transplant candidates and recipients with hepatitis C virus (HCV)-related liver disease greatly benefit from an effective antiviral therapy. The achievement of a sustained virological response before transplantation can prevent the recurrence of post-transplant HCV disease that occurs universally and correlates with enhanced progression to graft cirrhosis. Previous standard-of-care regimens (e.g., pegylated-interferon plus ribavirin with or without first generation protease inhibitors, boceprevir and telaprevir) displayed suboptimal results and poor tolerance in liver transplant recipients. A new class of potent direct-acting antiviral agents (DAA) characterized by all-oral regimens with minimal side effects has been approved and included in the recent guidelines for the treatment of liver transplant recipients with recurrent HCV disease. Association of sofosbuvir with ribavirin and/or ledipasvir is recommended in liver transplant recipients and patients with decompensated cirrhosis. Other regimens include simeprevir, daclatasvir, and combination of other DAA. Possible interactions should be monitored, especially in coinfected human immunodeficiency virus/HCV patients receiving antiretrovirals.
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Ferreira PRA, Silva MHD, Brandão-Melo CE, Rezende RE, Gonzalez M, Reuter T, Urbaez JD, Gianini RJ, Martinelli A, Mendes-Correa MC. The clinical effectiveness of pegylated interferon and ribavirin for the treatment of chronic hepatitis C in HIV-infected patients in Brazil: a multicentric study. Braz J Infect Dis 2014; 19:15-22. [PMID: 25181403 PMCID: PMC9425268 DOI: 10.1016/j.bjid.2014.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/09/2014] [Accepted: 08/01/2014] [Indexed: 02/03/2023] Open
Abstract
Introduction in Brazil, chronic hepatitis C in patients coinfected with the human immunodeficiency virus (HIV) is treated with pegylated interferon (Peg-IFN) and ribavirin (RBV). However, few studies have evaluated the effectiveness of this treatment in this particular population. The identification of the factors that predict sustained virological response (SVR) under current clinical practice would enable clinicians to more accurately estimate the probability of achieving an SVR and therefore utilize the appropriate therapeutics, especially in the era of direct-acting antiviral (DAA) agents. Aims the primary aim of our study was to determine the SVR rate under current clinical practice. The secondary aims were as follows: (1) to determine the factors before and during treatment that predict SVR; and (2) to identify the causes of treatment interruption. Methods within a cohort of HIV/hepatitis C virus (HCV)-coinfected patients in Brazil, we performed a retrospective analysis of those individuals treated with Peg-IFN and RBV. Results among the 382 analyzed patients, SVR was observed in 118 [30.9% (95% confidence interval (CI): 26.3–35.8)], which included 25.9% (75/289) of the patients with genotypes 1 and 4 and 48.2% (41/85) of those with genotypes 2 and 3. After multivariate analyses the independent positive predictors for SVR after treatment for chronic hepatitis C with Peg-IFN and RBV were: absence of an AIDS-defining illness (p = 0.001), HCV viral load lower than 600,000 IU/mL at the onset of treatment (p = 0.003), higher liver enzyme levels (p = 0.039) at baseline, infection with genotypes 2 or 3 (p = 0.003), and no transient treatment interruption (p = 0.001). The treatment was interrupted in 25.6% (98/382) of the patients because of adverse events (11.3%, 43/382), virologic failure (7.8%, 30/382), and dropout (6.5%, 43/382). The main adverse events were cytopenia and psychiatric disorders. Conclusions in our Brazilian case series, the SVR rate under current clinical practice conditions was similar to that reported in other studies. There was a correlation between an SVR and being infected by genotypes 2 and 3, low viral load, high ALT levels at the onset of treatment, and absence of an AIDS-defining illness. Cytopenia and psychiatric disorders were the major causes of treatment interruption. Efforts should be focused on optimizing management of side effects and counseling to improve adherence and to keep patients on treatment.
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Affiliation(s)
| | - Mariliza Henrique da Silva
- Centro de Referência e Tratamento DST-AIDS de São Paulo, São Paulo, Brazil; Clínica de Especialidades de São Bernardo do Campo, São Paulo, Brazil
| | | | - Rosamar Eulira Rezende
- Centro de Especialidades - Ambulatório de Hepatites, Secretaria Municipal de Saúde de Ribeirão Preto, São Paulo, Brazil
| | - Mário Gonzalez
- Instituto de Infectologia Emilio Ribas, São Paulo, Brazil
| | - Tânia Reuter
- Disciplina de Infectologia - Universidade Federal do Espírito Santo - UFES, Vitória, Brazil
| | | | - Reinaldo Jose Gianini
- Laboratório de Investigação Médica em Epidemiologia e Estatística, Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, Brazil
| | - Ana Martinelli
- Divisão de Gastroenterologia da Faculdade de Medicina da Universidade de São Paulo, Ribeirão Preto, Brazil
| | - Maria Cássia Mendes-Correa
- Departamento de Doenças Infecciosas e Parasitárias da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Baccarani U, Righi E, Adani GL, Lorenzin D, Pasqualucci A, Bassetti M, Risaliti A. Pros and cons of liver transplantation in human immunodeficiency virus infected recipients. World J Gastroenterol 2014; 20:5353-5362. [PMID: 24833865 PMCID: PMC4017050 DOI: 10.3748/wjg.v20.i18.5353] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 12/05/2013] [Accepted: 01/20/2014] [Indexed: 02/06/2023] Open
Abstract
Before the introduction of combined highly active antiretroviral therapy, a positive human immunodeficiency virus (HIV) serological status represented an absolute contraindication for solid organ transplant (SOT). The advent of highly effective combined antiretroviral therapy in 1996 largely contributed to the increased demand for SOT in HIV-positive individuals due to increased patients’ life expectancy associated with the increasing prevalence of end-stage liver disease (ESLD). Nowadays, liver failure represents a frequent cause of mortality in the HIV-infected population mainly due to coinfection with hepatitis viruses sharing the same way of transmission. Thus, liver transplantation (LT) represents a reasonable approach in HIV patients with stable infection and ESLD. Available data presently supports with good evidence the practice of LT in the HIV-positive population. Thus, the issue is no longer “whether it is correct to transplant HIV-infected patients”, but “who are the patients who can be safely transplanted” and “when is the best time to perform LT”. Indeed, the benefits of LT in HIV-infected patients, especially in terms of mid- and long-term patient and graft survivals, are strictly related to the patients’ selection and to the correct timing for transplantation, especially when hepatitis C virus coinfection is present. Aim of this article is to review the pros and cons of LT in the cohort of HIV infected recipients.
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Garbuglia AR, Monachetti A, Galli C, Sabatini R, Ferreri ML, Capobianchi MR, Bagnarelli P. HCV core antigen and HCV-RNA in HIV/HCV co-infected patients with different HCV genotypes. BMC Infect Dis 2014; 14:222. [PMID: 24758157 PMCID: PMC4029812 DOI: 10.1186/1471-2334-14-222] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 04/15/2014] [Indexed: 12/17/2022] Open
Abstract
Background A good correlation between HCV core antigen (HCVAg) and different HCV-RNA assays has been described, but little data are available in HCV/HIV co-infection. We aimed to evaluate HCVAg in comparison with HCV-RNA and to determine their kinetics during antiviral treatment in selected HCV/HIV co-infected patients. Methods 355 samples from 286 HCV/HIV co-infected subjects for whom HCV-RNA (Abbott RealTime) was requested were analysed also for HCVAg (Abbott ARCHITECT) in order to evaluate the correlation between the two parameters both in patients treated or untreated for chronic hepatitis C and according to different HCV genotypes. The differences between percentages were evaluated by chi square or Fisher’s exact test, while mean and median values were compared by Student’s t test or the Mann–Whitney test, respectively. All differences were considered significant for a p value <0.05. Results HCVAg was detectable on 288/315 sera (91.4%) positive for HCV-RNA and in 5 out of40 (12.5%) sera with undetectable HCV-RNA for a total concordance of 90.1%. The correlation was fair both in untreated (r = 0.742) and in treated (r = 0.881) patients and stronger for genotypes 1 and 4 than for genotype 3. Both HCV-RNA and HCVAg levels were significantly higher (p = 0.028 and p = 0.0098, respectively) in patients infected by genotype 1 than by genotype 3. The mean ratio of Log values between HCV-RNA (IU/mL) and HCVAg (fmol/liter) was 2.27 ± 1.09 in untreated and 2.20 ± 0.82 in treated patients (p = n.s.),consistent with a sensitivity of HCVAg corresponding to about 1,000 IU/mL of HCV-RNA, and ranged from 2.21 to 2.32 among HCV genotypes with no significant differences; five samples (1.4%; 2 genotype 1a or 1c, 3 genotype 3a) showed highly divergent values. The analysis of 18 monitoring profiles from patients treated with PEG-IFN and Ribavirin showed similar trends, except in one case in which relapse could be predicted by HCVAg and not by HCV-RNA. Conclusion These results suggest that HCVAg represents an adequate tool for determining an ongoing HCV infection also in HIV co-infected patients, with lower costs and faster turnaround time than HCV-RNA.
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Affiliation(s)
- Anna Rosa Garbuglia
- Virology, Laboratory of Virology, "L,Spallanzani" National Institute for Infectious Diseases, Via Portuense, 292, 00149 Rome, Italy.
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Davies A, Singh KP, Shubber Z, duCros P, Mills EJ, Cooke G, Ford N. Treatment outcomes of treatment-naïve Hepatitis C patients co-infected with HIV: a systematic review and meta-analysis of observational cohorts. PLoS One 2013; 8:e55373. [PMID: 23393570 PMCID: PMC3564801 DOI: 10.1371/journal.pone.0055373] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 12/22/2012] [Indexed: 12/14/2022] Open
Abstract
Introduction Co-infection with Hepatitis C (HCV) and HIV is common and HIV accelerates hepatic disease progression due to HCV. However, access to HCV treatment is limited and success rates are generally poor. Methods We conducted a systematic review and meta-analysis to assess HCV treatment outcomes in observational cohorts. Two databases (Medline and EMBASE) were searched using a compound search strategy for cohort studies reporting HCV treatment outcomes (as determined by a sustained virological response, SVR) in HIV-positive patients initiating HCV treatment for the first time. Results 40 studies were included for review, providing outcomes on 5339 patients from 17 countries. The pooled proportion of patients achieving SVR was 38%. Significantly poorer outcomes were observed for patients infected with HCV genotypes 1 or 4 (pooled SVR 24.5%), compared to genotypes 2 or 3 (pooled SVR 59.8%). The pooled proportion of patients who discontinued treatment due to drug toxicities (reported by 33 studies) was low, at 4.3% (3.3–5.3%). Defaulting from treatment, reported by 33 studies, was also low (5.1%, 3.5–6.6%), as was on-treatment mortality (35 studies, 0.1% (0–0.2%)). Conclusions These results, reported under programmatic conditions, are comparable to those reported in randomised clinical trials, and show that although HCV treatment outcomes are generally poor in HIV co-infected patients, those infected with HCV genotypes 2 or 3 have outcomes comparable to HIV-negative patients.
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Affiliation(s)
- Anna Davies
- Department of Infectious Diseases, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Kasha P. Singh
- Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
- Division of Infection and Immunity, University College Hospital, London, United Kingdom
| | - Zara Shubber
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Philipp duCros
- Manson Unit, Médecins Sans Frontières, London, United Kingdom
| | - Edward J. Mills
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Graham Cooke
- Department of Infectious Diseases, Faculty of Medicine, Imperial College, London, United Kingdom
| | - Nathan Ford
- Department of Infectious Diseases, Faculty of Medicine, Imperial College, London, United Kingdom
- Manson Unit, Médecins Sans Frontières, London, United Kingdom
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
- * E-mail:
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Arrivillaga M, Springer AE, Lopera M, Correa D, Useche B, Ross MW. HIV/AIDS treatment adherence in economically better off women in Colombia. AIDS Care 2012; 24:929-35. [DOI: 10.1080/09540121.2011.647678] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Marcela Arrivillaga
- a Department of Public Health & Epidemiology, Health & Quality of Life Research Group , Pontificia Universidad Javeriana Cali , Cali , Colombia
| | - Andrew E. Springer
- b Michael & Susan Dell Center for Advancement of Healthy Living , University of Texas School of Public Health-Austin Regional Campus , Austin , TX , USA
| | - Monica Lopera
- c National Faculty of Public Health , University of Antioquia , Medellín , Colombia
| | - Diego Correa
- d Health & Quality of Life Research Group , Pontificia Universidad Javeriana Cali , Cali , Colombia
| | - Bernardo Useche
- e Associate Researcher Health & Quality of Life Research Group , Pontificia Universidad Javeriana Cali , Colombia
| | - Michael W. Ross
- f Center for Health Promotion and Prevention Research, School of Public Health Houston , University of Texas , Houston , TX , USA
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Kozielewicz D, Dybowska D, Halota W, Dróżdż W. Natural leukocyte interferon alpha (Alfaferone) combined with ribavirin in the treatment of patients with HCV-related cirrhosis: our experience. Infection 2011; 39:433-7. [PMID: 21739360 PMCID: PMC3195818 DOI: 10.1007/s15010-011-0135-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 06/09/2011] [Indexed: 01/22/2023]
Abstract
BACKGROUND The aim of the study was to evaluate the efficacy and safety of combined treatment with natural leukocyte interferon alpha (Alfaferone) plus ribavirin in patients with HCV-related cirrhosis. PATIENTS AND METHODS Twenty-three patients (15 women, 8 men) aged 17-68 years hospitalized in 2005-2008 were included in the study. Seventeen patients who qualified for treatment were Child-Pugh class A patients and 6 others were class B. Seventeen patients had genotype 1b and 6 genotype 3a infection. Thirteen patients were naïve, retherapy concerned 8 patients, and in two cases the continuation of treatment had been stopped because of adverse events following the use of pegylated interferons. The treatment was continued for 48 weeks regardless of HCV genotype. Normalized AlAT activity (<40 U/l) was the measure of biochemical efficacy of the treatment, while virological efficacy was reflected by an undetectable viral load in plasma. Both measurements were conducted immediately after the end of treatment (EOT) and after a 6-month follow-up period (SVR). Therapeutic safety was evaluated by the monitoring of the adverse events of the treatment. RESULTS Abnormal AlAT levels prior to treatment were detected in 20/23 patients. During therapy normalized levels were achieved in 50% of them, and after 6 months they were sustained in 9/20. EOT was achieved in 6/19 patients and SVR in 3 patients. Mild psychiatric disorders were the most frequently detected adverse events (12 patients). Thrombocytopenia and leucopenia existing prior to treatment did not intensify during the treatment. Severe adverse events caused by the drug resulted in the discontinuation of treatment in three patients (urinary tract infections, depression, myasthenia gravis), of whom two patients were Child-Pugh class A and one was class B. In one patient treatment was discontinued because of HCC. CONCLUSION Natural leukocyte interferon alpha is well tolerated by patients with HCV-related cirrhosis and coexisting thrombocytopenia and leucopenia.
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Affiliation(s)
- D Kozielewicz
- Dept. of Infectious Diseases and Hepatology, Collegium Medicum, N. Copernicus University, 85-090 Bydgoszcz, ul. Św.Floriana 12, Toruń, Poland.
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Deming P, McNicholl IR. Coinfection with Human Immunodeficiency Virus and Hepatitis C Virus: Challenges and Therapeutic Advances Insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy 2011; 31:357-368. [DOI: 10.1592/phco.31.4.357] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Cacoub P, Halfon P, Rosenthal E, Bailly F, Sadr FB, Benhamou Y, Chevaliez S, Pawlotsky JM, Piroth L, Yazdanpanah Y, Pol S. Care of hepatitis C virus infection in human immunodeficiency virus-infected patients: modifications in three consecutive large surveys between 2004 and 2009. J Hepatol 2010; 53:230-7. [PMID: 20493575 DOI: 10.1016/j.jhep.2010.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Revised: 02/09/2010] [Accepted: 03/15/2010] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIMS To analyze the care of HCV infection in HIV-HCV coinfected patients and its progression between 2004 and 2009. METHODS Three hundred eighty HIV-HCV coinfected patients were prospectively included from November 22 to 29, 2004 (2004 survey), 416 patients from April 3 to 10, 2006 (2006 survey), and 419 patients from June 15 to 22, 2009 (2009 survey). RESULTS The rate of liver biopsy decreased (14% vs. 38% vs. 56%), while the use of non-invasive liver damage tests increased (47% vs. 24% vs. ND) in the 2009, 2006, and 2004 surveys, respectively. The rate of patients that had never been treated for HCV infection progressively decreased in the 2009, 2006, and 2004 surveys (37%, 42%, and 54%). The main reasons for HCV non-treatment changed as HCV treatment was deemed less questionable and the lack of liver biopsy became a very rare reason (6%, 18%, and 34%). Among patients treated for HCV infection, the rate of sustained virological response increased (49%, 29%, and 29%). The main factors independently associated with HCV treatment were a liver fibrosis score > or =F2 (odds ratio=3.5; 95% CI 2.1-5.7), a liver biopsy activity grade > or =A2 (2.7; 1.4-5.3), a CD4 cell count > or =350 ml (2.7; 1.6-4.4), European origin (2.1; 1.3-3.4), daily alcohol consumption<30 g (2.1; 1.2-3.8), and male gender (2.0; 1.2-3.3). CONCLUSION Compared to the 2004 and 2006 surveys, the 2009 coinfected patients had liver damage assessment more frequently, more patients had received HCV treatment and more patients had achieved a sustained virological response.
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Affiliation(s)
- Patrice Cacoub
- Université Pierre et Marie Curie-Paris6, CNRS, UMR 7211, France.
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Emery J, Pick N, Mills EJ, Cooper CL. Gender differences in clinical, immunological, and virological outcomes in highly active antiretroviral-treated HIV-HCV coinfected patients. Patient Prefer Adherence 2010; 4:97-103. [PMID: 20517470 PMCID: PMC2875719 DOI: 10.2147/ppa.s9949] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The influence of biological sex on human immunodeficiency virus (HIV) antiretroviral treatment outcome is not well described in HIV-hepatitis C (HCV) coinfection. METHODS We assessed patients' clinical outcomes of HIV-HCV coinfected patients initiating antiretroviral therapy attending the Ottawa Hospital Immunodeficiency Clinic from January 1996 to June 2008. RESULTS We assessed 144 males and 39 females. Although similar in most baseline characteristics, the CD4 count was higher in females (375 vs 290 cells/muL). Fewer females initiated ritonavir-boosted regimens. The median duration on therapy before interruption or change was longer in males (10 versus 4 months) (odds ratio [OR] 1.40 95% confidence interval: 0.95-2.04; P = 0.09). HIV RNA suppression was frequent (74%) and mean CD4 count achieved robust (over 400 cells/muL) at 6 months, irrespective of sex. The primary reasons for therapy interruption in females and males included: gastrointestinal intolerance (25% vs 19%; P = 0.42); poor adherence (22% vs 15%; P = 0.31); neuropsychiatric symptoms (19% vs 5%; P = 0.003); and lost to follow-up (3% vs 13%; P = 0.08). Seven males (5%) and no females discontinued therapy for liver-specific complications. Death rate was higher in females (23% vs 7%; P = 0.003). CONCLUSION There are subtle differences in the characteristics of female and male HIV-HCV coinfected patients that influence HIV treatment decisions. The reasons for treatment interruption and change differ by biological sex. This knowledge should be considered when starting HIV therapy and in efforts to improve treatment outcomes.
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Affiliation(s)
- Joel Emery
- The Ottawa Hospital Division of Infectious Diseases, University of Ottawa, Ottawa, Canada
| | - Neora Pick
- Oak Tree Clinic, BC Women’s Hospital, Vancouver, Canada
| | - Edward J Mills
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Curtis L Cooper
- The Ottawa Hospital Division of Infectious Diseases, University of Ottawa, Ottawa, Canada
- Correspondence: Curtis Cooper, Associate Professor of Medicine, University of Ottawa, The Ottawa Hospital-General Campus, G12-501 Smyth Rd, Ottawa, Ontario, Canada, K1H 8L6, Email
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Singal AK, Anand BS. Management of hepatitis C virus infection in HIV/HCV co-infected patients: Clinical review. World J Gastroenterol 2009; 15:3713-24. [PMID: 19673011 PMCID: PMC2726448 DOI: 10.3748/wjg.15.3713] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Nearly one fourth of individuals with human immunodeficiency virus (HIV) infection have hepatitis C virus (HCV) infection in the US and Western Europe. With the availability of highly active antiretroviral therapy and the consequent reduction in opportunistic infections, resulting in the prolongation of the life span of HIV-infected patients, HCV co-infection has emerged as a significant factor influencing the survival of HIV patients. Patients with HIV/HCV co-infection have a faster rate of fibrosis progression resulting in more frequent occurrences of cirrhosis, end-stage liver disease, and hepatocellular carcinoma. However, the mechanism of interaction between the two viruses is not completely understood. The treatment for HCV in co-infected patients is similar to that of HCV mono-infection; i.e., a combination of pegylated interferon and ribavirin. The presence of any barriers to anti-HCV therapy should be identified and eliminated in order to recruit all eligible patients. The response to treatment in co-infected patients is inferior compared to the response in patients with HCV mono-infection. The sustained virologic response rate is only 38% for genotype-1 and 75% for genotype-2 and -3 infections. Liver transplantation is no longer considered a contraindication for end-stage liver disease in co-infected patients. However, the 5 year survival rate is lower in co-infected patients compared to patients with HCV mono-infection (33% vs 72%, P = 0.07). A better understanding of liver disease in co-infected patients is needed to derive new strategies for improving outcome and survival.
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