October 27, 2001
Dr. Lorna Dove gave us an overview of hepatitis C and HIV infection. She reviewed epidemiology, clinical manifestations and treatment of hepatitis C infection in HIV/AIDS patients. She presented some data showing an increase in the frequency of deaths secondary to end-stage liver disease in the HIV-infected population, making the point (well known by the audience) that we need to do something about this.
Although hepatitis C is not clearly transmitted sexually in an HIV-negative person, there is not enough data to say this about the HIV-infected population. Dr. Dove thought that the risk of sexual acquisition might possibly be higher in this group than in others. HIV definitely increases the risk of fibrosis and cirrhosis associated with HCV infection. HCV co-infection might decrease the survival of HIV-infected individuals, although the studies in this regard are not definitive. After starting HAART there is a transient increase in hepatitis C viral load and a transient increase in transaminases that returns to baseline levels quickly. HAART has a beneficial effect and decreases the risk of progression to cirrhosis in co-infected patients. However not everything is good news: there is an increased risk of hepatotoxicity in co-infected patients, as well as an increased risk of mitochondrial toxicity associated with NRTI, especially in patients on ribavirin.
Dr. Dove then reviewed the current state-of-the-art therapy for hepatitis C infection in HIV-infected patients: the combination of pegylated interferon and ribavirin. The definitive studies in this regard have not yet been presented but are coming early next year. The sustained virologic responses are around 40-80% depending on the hepatitis C genotype (with type 2 and 3 easier to treat than type 1). The response rate to this treatment does not seem to be very different between HIV-positive and HIV-negative patients.
Dr. Dove raised the issue of the interactions between AZT and ribavirin (there is a concern of an antagonistic effect similar to the one between d4T and AZT), but she pointed out that this problem has not been seen in vivo yet. She concluded her talk by discussing the role of liver transplantation. Her unit in UCSF has already done three transplants in HIV-infected patients -- something unthinkable only a couple of years ago. We definitely have come a long way since the era in which we used to ignore hepatitis C virus infections in people who were HIV positive.
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