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Coinfection

DDW 2009: Does HIV/HCV Coinfection Increase the Risk of Liver Disease Progression and Worsen Clinical Outcomes?

A growing body of evidence indicates that HIV positive people coinfected with chronic hepatitis C virus (HCV) infection tend to experience more rapid liver disease progression, although not all studies have seen this effect, especially among individuals who are taking highly active antiretroviral therapy (HAART) and have relatively high CD4 cell counts. The stream of conflicting data continued at the Digestive Disease Week (DDW 2009) annual meeting last week in Chicago, with one study finding no difference in fibrosis progression between HCV monoinfected and HIV/HCV coinfected people, while another showed worse clinical outcomes in coinfected patients.

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CROI 2009: High HCV Viral Load Is Associated with an Increased Risk of Death in HIV-HCV Coinfected Individuals

In contrast with HIV, most studies to date indicate that hepatitis C virus (HCV) viral load is not associated with disease progression. But this may not be the case for HIV-HCV coinfected individuals, according to a study presented at the 16th Conference on Retroviruses and Opportunistic Infections (CROI 2009) last month in Montreal.

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Liver Enzyme Elevation after Lamivudine (Epivir) Withdrawal in HIV-HBV Coinfected Patients

Assessment of liver enzyme elevation in HIV positive patients coinfected with hepatitis B virus (HBV) can be complicated, since increases may be attributable to multiple causes including heavy alcohol use, liver toxicity related to antiretroviral therapy (ART), immune reconstitution due to effective anti-HIV therapy, and exacerbation of HBV infection -- especially when anti-HBV therapy is discontinued.

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CROI 2009: British Study Finds HIV-HCV Coinfected Patients Do Not Have Impaired CD4 Cell Recovery after Starting HAART

Studies to date have produced conflicting data on the question of whether HIV-HCV coinfected individuals experience slower or less extensive CD4 cell recovery after starting antiretroviral therapy (ART). 

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Adefovir plus Hepatitis C Therapy May Prevent HBV Reactivation in HBV-HCV Coinfected Patients

Due to the similar transmission routes, many people are dually infected with both hepatitis B virus (HBV) and hepatitis C virus (HCV). While the interaction between these 2 viruses is not fully understood, studies have shown that HBV seems to inhibit HCV replication and vice versa. As such, there is a risk that successful treatment of one virus could potentially lead to worsening or reactivation of the other.

In a brief report in the December 2008 European Journal of Gastroenterology and Hepatology, French researchers described a case in which an HBV-HCV coinfected patient was simultaneously treated with both interferon-based therapy for chronic hepatitis C and the FDA-approved anti-HBV drug adefovir (Hepsera).

The authors observed that HBV reactivation as the result of HCV eradication was prevented by treating both viral infections together.

This finding, they concluded, "raises the question as to whether preemptive HBV treatment should be prescribed along with HCV treatment to prevent HBV from being [reactivated] after HCV eradication in coinfected HBV-HCV patients."

1/16/09

Reference

C Renou, JF Cadranel, A Pariente, and others. Adefovir combined with hepatitis C virus treatment may prevent hepatitis B reactivation after hepatitis C virus eradication in hepatitis B and C virus carriers. European Journal of Gastroenterology and Hepatology 20(12):1235-1237. December 2008. (Abstract).

 

CROI 2009: Antiretroviral Treatment Interruption May Affect HCV Viral Load, HBV Rebound, and Liver Fibrosis Progression in Coinfected Patients

Over the past few years, evidence has accumulated showing that antiretroviral treatment interruption is a potentially risky strategy, and that ongoing HIV replication is associated with a variety of non-AIDS conditions even in people with relatively well-preserved immune function.

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Boosted Atazanavir (Reyataz) and Etravirine (Intelence) Are Safe and Well-tolerated in Patients with Hepatitis B or C Coinfection

Antiretroviral therapy (ART) may cause liver toxicity, indicated by elevated liver enzymes, and studies have shown that this is more likely to occur in HIV positive individuals with hepatitis B virus (HBV) or hepatitis C virus (HCV) coinfection. Two studies presented at the recent 9th International Congress on Drug Therapy in HIV Infection in Glasgow, Scotland, looked at the safety of 2 newer antiretroviral drugs in patients with hepatitis B or C.

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Adequate Ribavirin Level Promotes Sustained Response to Interferon-based Therapy for HIV-HCV Coinfected Patients

Ribavirin plays an important role in preventing relapse after completion of interferon-based therapy for chronic hepatitis C. But this treatment does not work as well in HIV/HCV coinfected people, and the effects of ribavirin in this group are not fully understood.

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ICAAC 2008: HAART Is Associated with Reduced Liver Inflammation in HIV-HCV Coinfected Patients

Several past studies have shown that HIV positive people with chronic hepatitis C virus (HCV) coinfection tend to experience more rapid and perhaps more severe liver disease progression, leading some experts to suggest that such patients should perhaps start interferon-based therapy sooner.

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