September 15, 2003
Curtis Cooper presented data from the Viral Hepatitis Program of the University of Ottawa. They performed a retrospective study of patients infected with HCV alone (n=287) and patients coinfected with HCV and HIV (n=247). One hundred and thirty of the patients with HCV alone and 20 of the HCV/HIV patients underwent a liver biopsy. They found that those patients who were HIV positive had a faster rate of liver fibrosis. They observed a trend towards antiretroviral therapy being associated with a slower rate of fibrosis, but their power to detect a difference was limited by the small number of biopsies performed on HCV/HIV patients.
They also reviewed the outcomes of HCV/HIV patients who started antiretroviral therapy. They found that 64 (26 percent) did not initiate antiretroviral therapy, and 59 (24 percent) either discontinued antiretroviral therapy or were lost to follow-up. Of the 130 who started antiretroviral therapy and had a subsequent HIV RNA (viral load), 104 (80 percent) had at least one HIV RNA below 500 copies/mL.
Among those patients staying on antiretroviral therapy for six months and 12 months, 79 percent and 83 percent, respectively, had HIV RNA below 500 copies/mL. Interrupting antiretroviral therapy was associated with drinking more than 50 grams of alcohol a day (around two to three drinks) and having intravenous drug use as the risk factor for HCV/HIV infection.
In contrast to the successful outcomes for HIV therapy, the response to HCV treatment was less successful. Eleven HCV/HIV patients were treated for HCV with interferon and ribavirin. One patient stopped therapy prior to six months of treatment. Only one patient (11 percent) out of nine having HCV genotype 1 had a sustained virologic response compared to seven (32 percent) out of 22 patients who were HIV negative having HCV genotype 1.
This study highlights the poor response to HCV treatment among HIV-positive people. It also found that successful outcomes from antiretroviral therapy can be achieved, but changes in treatment and interruptions in treatment are very common. It suggests that alcohol consumption may lead to interruptions in antiretroviral therapy. Alcohol consumption has previously been shown to hasten complications from HCV as well and is strongly discouraged. Larger studies similar to this should be forthcoming as more and more clinical centers begin treating HCV infection among HIV-positive individuals.
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