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and Hepatitis.com Coverage of the
17th Conference on Retroviruses and
Opportunistic Infections (CROI 2010)
February 16 - 19, San Franciso, California
Leakage of Gut Bacteria Linked to Poor Hepatitis C Treatment Response in HIV/HCV Coinfected Patients
One of the earliest manifestations of HIV disease is injury to the lining of the intestines as HIV infects the many CD4 T-cells there. This damage can allow microbes residing in the gut to leak out. As these bacteria and their toxins such as lipopolysaccharide (LPS) enter the bloodstream a process known as microbial translocation they trigger generalized immune activation, and the resulting inflammatory response appears to contribute to a variety of non-AIDS conditions seen in people with HIV.
Given that laboratory and animal studies have shown that exposure to LPS can result in liver inflammation and fibrosis, Giusi Maria Bellistri and colleagues from Italy hypothesized that microbial translocation might be relevant to hepatitis C disease progression and treatment response in HIV/HCV coinfected patients, possibly related to immune hyper-activation.
In this cross-sectional study, the researchers analyzed 98 HIV/HCV coinfected patients on combination antiretroviral therapy (ART) who had HIV viral loads <50 copies/mL. All participants started hepatitis C treatment using pegylated interferon alfa plus weight-adjusted ribavirin (1000-1200 mg).
looked at early virological response, defined as HCV RNA < 15 IU/mL
at week 12 of therapy. Advanced fibrosis was defined as a Knodell score
of F3 to F4 based on liver biopsy, or liver stiffness >12.5 kPa using
FibroScan. They also looked at LPS levels and markers of immune activation,
including HLA-DR, CD38, CD4/CD8 and soluble CD14 (sCD14), a protein
that plays a key role in responding to LPS.
on these findings, the researchers concluded, "HIV/HCV coinfected
patients lacking early response to HCV therapy display heightened microbial