Clinical outcomes of HIV-HCV co-infection in a large cohort of hemophiliac patients

Lichterfeld, Mathias; Schmeißer, Norbert; Qurishi, Nazifa; Vogel, Martin; Brackmann, Hans‐Hermann; Spengler, Ulrich; Rockstroh, Juergen

doi:10.1016/j.jinf.2004.04.003

Cited by 14 publications

(15 citation statements)

References 25 publications

(18 reference statements)

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“…14 Both cumulative incidence of end-stage liver disease and fatality due to liver failure have been reported to be significantly increased in the dually infected hemophiliac compared with the HCV-monoinfected hemophiliac. 15,17 HAART was associated with an increased time to end-stage liver disease in HCV/HIV positive patients, similar to that observed in HCV positive, HIV negative patients. 18 Hepatitis B and C markers are highly prevalent among older males with hemophilia.…”

Section: Viral Diseasesupporting

confidence: 70%

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The Aging Patient with Hemophilia: Complications, Comorbidities, and Management Issues

Philipp

2010

Hematology

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Improvements in hemophilia care and antiviral treatments have resulted in increases in median life expectancy for persons with congenital hemophilia A and B. Currently, 2% of hemophilia A and B patients surveyed in US comprehensive hemophilia treatment centers are 65 years of age or older and 15% are 45 years or older. Many of the complications of hemophilia, including intracranial hemorrhage, joint disease, and inhibitor development, increase with increasing age. Hepatocellular carcinoma and end-stage liver disease are increasing in the older hemophilia population due to infection with hepatitis C (HCV) and HCV/HIV coinfection. Older hemophilia patients also now face the same medical conditions associated with aging in the general population, including cardiovascular disease and cancer. Complex hemostatic management, sometimes in conjunction with antithrombotic management, with extensive cross-specialty clinical and laboratory coordination may be required for the care of the older hemophilia patient. Because elderly hemophilia patients currently represent a small portion of the overall hemophilia population, there is little in the way of clinical data to guide recommendations. Registry databases and cooperative group studies are needed for the development of evidence-based guidelines for the older hemophilia population, which is anticipated to expand in the future.

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Section: Viral Diseasesupporting

confidence: 70%

“…[13][14][15] Younger age at the time of HIV seroconversion has been associated with improved survival. 14,16 Most HIV-infected hemophilia patients are coinfected; among 458 HIV-positive hemophilia A and B patients in Canada, 96.5% were hepatitis C (HCV) positive.…”

Section: Viral Diseasementioning

confidence: 99%

The Aging Patient with Hemophilia: Complications, Comorbidities, and Management Issues

Philipp

2010

Hematology

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“…The HIV viral load response to therapy was similar, however, in patients with and without HCV. This deleterious effect is confirmed in some, but not all other studies [165][166][167].…”

Section: Natural Historymentioning

confidence: 75%

British HIV Association guidelines for the management of coinfection with HIV‐1 and hepatitis B or C virus 2010

et al. 2009

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“…Samples above the reporting range were diluted 1:100 in HCV-negative human plasma and retested to determine viral titer. Quantitative HCV RNA testing was performed at hours 0, 3,6,9,12,15,18,24,30,36,48,72,96, and days 7 and 14, and weeks 4,8,12,16,24,32,40, 48, 52, 60, and 72 after treatment initiation. Samples below the limit of detection were tested with the qualitative Roche COBAS HCV Amplicor assay, version 2.0.…”

Section: Methodsmentioning

confidence: 99%

“…3 Liver disease is a major cause of morbidity and mortality in this patient population, 4,5 and increased rates of progression to end-stage liver disease in HCV/HIV-1 coinfection have been well-documented in patients with hemophilia. [5][6][7][8][9] Although treatment with pegylated interferon plus ribavirin (peg-IFN ϩ r) has been shown to achieve sustained viral response (SVR) in up to 60% of monoinfected patients, 10,11 response rates in HCV/HIV-1-coinfected patients range from 27% to 44%. [12][13][14] Studies of response to peg-IFN ϩ r in patients with inherited bleeding disorders are scarce, and predictors of response to treatment other than HCV genotype are poorly characterized.…”

mentioning

confidence: 99%

HCV kinetics, quasispecies, and clearance in treated HCV-infected and HCV/HIV-1-coinfected patients with hemophilia

et al. 2006

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Hepatitis C virus (HCV) treatment response rates remain low in HCV/HIV-1-coinfected individuals compared with those with HCV alone. Persons with inherited coagulation disorders have high rates of HCV and HIV-1 infection, but HCV treatment trials in this patient population are scarce. We hypothesized that differences by infection status in HCV viral kinetics would be associated with differences in HCV quasispecies complexity over time and with treatment response disparities. Coinfected and monoinfected patients were enrolled in a treatment trial for pegylated-interferon alpha-2a (peg-IFN) ؉ ribavirin. Patients were treated for 48 weeks and followed for an additional 24. Quantitative HCV RNA was tested at multiple times during and after treatment. Viral kinetic parameters associated with response were estimated with a mathematical model. Quasispecies emergence was determined via heteroduplex complexity assay. Twenty-two patients were HCV RNA-positive at baseline, with no significant demographic or virological differences by infection status. Five of eleven (45%) of monoinfected and 3 of 11 (27%) of coinfected patients achieved sustained viral response (SVR). Peg-IFN efficacy (⑀) of 90% or greater was associated with probability of end-of-treatment response (ETR) (P ‫؍‬ .001) and SVR (P ‫؍‬ .06). Patients with SVR had lower baseline quasispecies complexity than those without SVR (P ‫؍‬ .07). Those with ⑀ of 90% or greater also had lower baseline complexity (P ‫؍‬ .07). Coinfection status mediated changes in complexity over time (P ‫؍‬ .04). In conclusion, low pretreatment quasispecies complexity may predict peg-IFN response; early peg-IFN response is critical for sustained HCV clearance and is altered in coinfection. Further studies are warranted. (HEPATOLOGY 2006;44:1146-1157

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Clinical outcomes of HIV-HCV co-infection in a large cohort of hemophiliac patients

Cited by 14 publications

References 25 publications

The Aging Patient with Hemophilia: Complications, Comorbidities, and Management Issues

The Aging Patient with Hemophilia: Complications, Comorbidities, and Management Issues

British HIV Association guidelines for the management of coinfection with HIV‐1 and hepatitis B or C virus 2010

HCV kinetics, quasispecies, and clearance in treated HCV-infected and HCV/HIV-1-coinfected patients with hemophilia

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