Treatment of Co-Infection Despite Very Low CD4+ Cell Counts
In general, treatment guidelines for HCV-HIV co-infection encourage the initiation of HCV therapy at counts well above the 200 CD4+ cell level. The reason for this is that HCV therapy can temporarily reduce CD4+ cell counts, and if these fall too low there is a risk that life-threatening infections could develop.
Researchers in Barcelona and elsewhere in Spain conducted a pilot study to evaluate the safety of HCV therapy in co-infected people with low CD4+ cell counts. Their results are surprising and may incite the initiation of larger studies to explore the issue of HCV therapy in people with low CD4+ cell counts.
Researchers recruited 11 co-infected volunteers, all who had HCV genotype 1 and who were taking anti-HIV therapy. None had hepatitis A or B or any other significant health condition. They were divided into two groups as follows:
- Group A: 5 participants with an average of 150 CD4+ cells
- Group B: 6 participants with an average of 450 CD4+ cells
All participants received standard treatment for HCV -- interferon and ribavirin adjusted according to body weight.
Preliminary results of 12 weeks of therapy were made available:
- Decreases in HCV viral load occurred and were similar in both groups.
- Although the CD4+ count fell to an average of 133 cells among those in group A, no life-threatening infections occurred.
- The CD4+ count among participants in group B (who began HCV therapy with higher CD4+ counts) fell to an average of 383 cells
Since no serious AIDS-related infections occurred and significant reductions in HCV viral load were seen, at least over the short-term, the Spanish researchers say that larger and longer studies are warranted in co-infected people with low CD4+ cell counts.
- von Wichmann MA, Crespo M, Rodriguez-Arrondo F, et al. Pilot study to evaluate safety and HCV kinetics in HCV/HIV co-infected patients with less than 200 CD4+, treated with peginterferon alfa-2b and ribavirin (P04675 study). In: Program and abstracts of the 18th International Conference on AIDS, 18-23 July 2010, Vienna, Austria. Abstract MOPE0178.