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Early Treatment of Acute HIV and Hepatitis C in People with Simultaneous Coinfection

Simultaneous early treatment of HIV and hepatitis C virus (HCV) during the acute phase of infection leads to good outcomes in people who contract both viruses at the same time, according to a study published in the August 1, 2009 issue of Clinical Infectious Diseases.

By Liz Highleyman

Most research to date indicates that treatment of HIV during primary or acute infection does not lead to superior long-term outcomes, while treating acute hepatitis C does produce high sustained response rates. There is limited data, however, about clinical outcomes and immunological response among people who acquire both viruses simultaneously.

Julian Schulze zur Wiesch and colleagues from Germany presented results of a detailed clinical and immunological analysis of 3 individuals with concomitant acute HCV and primary HIV infection. Two were infected via needle sticks (both HCV genotype 3) and one presumably through male-to-male sexual transmission (HCV genotype 1).

All received triple combination antiretroviral therapy (ART) for HIV and 48 weeks of pegylated interferon alfa for hepatitis C (1 also received ribavirin). The investigators looked at changes in viral load and CD4 cell count, as well as virus-specific T-cell immune responses.

Results

All 3 patients cleared HCV during pegylated interferon treatment, and maintained a sustained virological response 6 months after completing therapy.
All 3 also achieved undetectable HIV viral load while on ART.
2 patients maintained HIV suppression after interrupting ART.
This outcome was associated with strong HIV-specific CD8 and CD4 T-cell responses.
These 2 patients also exhibited multi-specific anti-HCV CD4 T-cell responses.
The third patient -- who had the lowest CD4 nadir (lowest level) during primary HIV infection (< 200 cells/mm3) -- showed no evidence of HCV-specific CD4 T-cell responses.

Based on these findings, the investigators concluded, "Anti-HIV and -HCV therapy should be considered early in cases of concomitant acute HCV and HIV coinfection, because successful therapy of HCV viremia seems possible even during primary HIV infection."

"HCV-specific T-cell immunity is generated during primary HIV infection and can be preserved by HCV treatment," they added. "However, the optimal treatment algorithm needs to be established in prospective, randomized trials."

Departments of Medicine and Transfusion Medicine, University Medical Center Hamburg-Eppendorf, Germany; Heinrich-Pette-Institute for Experimental Virology and Immunology, Hamburg, Germany.

9/11/09

Reference
J Schulze zur Wiesch, D Pieper, I Stahmer, and others. Sustained Virological Response after Early Antiviral Treatment of Acute Hepatitis C Virus and HIV Coinfection. Clinical Infectious Diseases 49(3): 466-472. August 1, 2009. (Abstract).