HIV and Hepatitis.com Coverage of the
42nd EASL Conference
April 11 - 15, 2007, Barcelona, Spain
THE EUROPEAN ASSOCIATION FOR THE STUDY OF THE LIVER

Spontaneous HCV Clearance Is Uncommon among HIV Positive Individuals, but Treatment Is Effective

By Liz Highleyman

Recent outbreaks of acute hepatitis C virus (HCV) infection among HIV positive men who have sex with men in several European cities provide an opportunity to learn more about the natural history and treatment of acute hepatitis C in HIV-HCV coinfected individuals.

As reported at the 42nd Annual Meeting of the European Association for the Study of the Liver this month in Barcelona, Spain, French researchers designed an ongoing study to assess the onset of HCV-specific immune responses during acute HCV infection in coinfected patients.

The investigators enrolled HIV positive individuals at the time of acute HCV infection, and plan to follow them for 15 months. Participants either had undetectable HIV viral load if on antiretroviral therapy or viral loads below 30,000 copies/mL if untreated for HIV. If patients did not spontaneously clear HCV by month 3, they were offered treatment with pegylated interferon plus ribavirin.

HCV-specific T-cell responses were assessed by lymphoproliferation and interferon-gamma Elispot assays using recombinant HCV proteins, with HIV p24 and CMV antigens used as controls.

Data from the first 29 patients with acute HCV infection with a follow-up period of at least 3 months were presented. In this group, the median CD4 cell count was 622 cells/mm3, the median HCV RNA level was 6.57 log10 IU/mL, and the median peak ALT level was 416 IU/L. Among these patients, 9 had HCV genotype 1a, 1 had genotype 2, 1 had genotype 3a, and 18 had genotype 4d -- indicating a probabley transmission cluster.

Results

  • At month 3, only 2 patients had experienced spontaneous HCV clearance.
  • 19 patients initiated anti-HCV treatment.
  • 8 refused hepatitis C treatment and became chronically infected.
  • After 4 weeks on anti-HCV therapy, 12 of 16 documented patients (75%) had undetectable HCV RNA.
  • Overall, 20 patients had a positive HCV-specific proliferative response on at least 1 occasion during follow-up against at least 1 HCV protein.
  • At month 3, HCV-specific proliferative responses were detected in 6 of 19 documented patients (32%); in comparison, 7 (37%) had responses against HIV p24 and 13 (68%) had responses against CMV antigens.
  • Among patients with HCV-specific responses, these were directed against the following proteins:
    • HCV core (5%);
    • NS3 (11%);
    • NS4 (16%);
    • NS5 (16%).
  • During anti-HCV therapy, frequencies of positive proliferative responses decreased against all HCV and control antigens.
  • In 4 patients with positive anti-HCV proliferative responses, specific effector responses could not be detected by interferon-gamma Elispot assays using HCV recombinant proteins, either ex vivo or after in vitro stimulation.

Conclusion

“In HIV coinfected patients we observed few HCV spontaneous clearances after the acute phase, and peripheral anti-HCV specific immune responses were of weak intensity,” the investigators concluded. “However, early anti-HCV treatment remains efficient in these patients.”

Pitie-Salpetriere Hospital, Paris, France; St. Antoine Hospital, Paris, France; Tenon Hospital, Paris, France.

04/20/07

Reference
A Schnuriger, S Dominguez, C Katlama, and others. Acute hepatitis C infection in HIV-infected patients: low rate of spontaneous clearance and weak hepatitis C virus-specific T cell responses. 42nd Annual Meeting of the European Association for the Study of the Liver. Barcelona, Spain. April 11-15, 2007.

 





























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