Evolution of Coinfection with Human Immunodeficiency Virus and Hepatitis C Virus in Patients Treated with Highly Active Antiretroviral Therapy

Torre, Donato; Tambini, Roberto; Cadario, F; Barbarini, Giorgio; Moroni, M; Basilico, Claudio

doi:10.1086/322611

Cited by 49 publications

(32 citation statements)

References 27 publications

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“…Our results are in conflict with other studies in coinfected patients, which have shown an association between genotype 1 infection and increased quasispecies diversity (38) and HCV load (1,49). However, none of these studies stratified patients based on exposure to HAART.…”

Section: Discussioncontrasting

confidence: 99%

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Impact of Highly Active Antiretroviral Therapy and Immunologic Status on Hepatitis C Virus Quasispecies Diversity in Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patients

Babik

Holodniy

2003

J Virol

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This study analyzes the effect of highly active antiretroviral therapy (HAART), and thus immunologic status, on hepatitis C virus (HCV) load and quasispecies diversity in patients coinfected with the human immunodeficiency virus (HIV) and HCV. Three cohorts of coinfected patients were analyzed retrospectively over a period of 7 to 10 months: group A was antiretroviral drug naïve at baseline and then on HAART for the remainder of the study, group B did not receive antiretroviral therapy at any point, and group C was on HAART for the entire study. HCV quasispecies diversity was analyzed by sequencing hypervariable region 1. In a longitudinal analysis, there was no significant change from baseline in any immunologic, virologic, or quasispecies parameter in any of the three groups. However, in comparison to groups A and B, group C had significantly higher CD4؉ -and CD8 ؉ -cell counts, a trend toward a higher HCV load, and significantly increased number of HCV clones, entropy, genetic distance, and ratio of nonsynonymous substitutions per nonsynonymous site to synonymous substitutions per synonymous site (K a /K s ). In addition, CD4؉ -cell count was positively correlated with HCV load, genetic distance, and K a . Interestingly, patients infected with HCV genotype 2 or 3 had a significantly higher CD4؉ -cell count, HCV load, genetic distance, and K a /K s than those infected with genotype 1. These results suggest that there is no immediate effect of HAART on HCV but that, with prolonged HAART, immune restoration results in an increase in HCV load and quasispecies diversity.

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Section: Discussioncontrasting

confidence: 99%

“…The effect of HAART on HCV load is still controversial. Most studies have shown no change in HCV RNA titers following HAART (11,37,49), although some studies have shown a transient (34,39) or sustained (35) increase in HCV load; yet others have shown a decrease in HCV RNA levels and in some cases even HCV clearance (55).…”

mentioning

confidence: 99%

Impact of Highly Active Antiretroviral Therapy and Immunologic Status on Hepatitis C Virus Quasispecies Diversity in Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patients

Babik

Holodniy

2003

J Virol

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“…Some studies have shown no significant changes in HCV RNA and alanine aminotransferase serum levels during HAART [73,74]. We have confirmed these results, and we also observed that, in a group of patients who showed increased levels of alanine aminotransferase during HAART, HCV RNA levels did not further increase [75]. In contrast, other investigators reported transient or persistent increases in HCV load during HAART [76,77].…”

Section: Liver Manifestationssupporting

confidence: 88%

Impact of highly active antiretroviral therapy on organ‐specific manifestations of HIV‐1 infection

2005

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In the last 10 years, interesting results have been reported concerning the impact of highly active antiretroviral therapy (HAART) on the changing pattern of organ-specific manifestations of HIV-1 infection. There has been a clear step-wise reduction in the incidence of several opportunistic infections (OIs), particularly Pneumocystis carinii pneumonia, whereas a nonsignificant reduction in incidence has been observed for other organ-specific diseases, including invasive cervical cancer and Hodgkin disease. In addition, several organ-specific manifestations, including HIV-associated nephropathy, wasting syndrome and cardiomiopathy, are a direct consequence of damage by HIV-1, and so HAART may have a therapeutic effect in improving or preventing these manifestations. Finally, the introduction of HAART has seen the emergence of several complications, termed immune reconstitution inflammatory syndrome, which includes OIs such as cytomegalovirus vitritis, Mycobacterium avium complex lymphadenitis, paradoxical responses to treatment for tuberculosis, and exacerbation of cryptococcosis. Because not all HIV-1 organ-specific manifestations are decreasing in the HAART era, this review will analyse the influence of HAART on several organ-specific manifestations, and in particular OIs related to several organs, cerebral disorders and HIV-1-related neoplasia.

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“…On the other hand, in a retrospective analysis of data from a cohort of 65 coinfected patients treated with HAART, Torre et al [63] did not report any significant changes in serum transaminase concentrations and HCV viral load during a 3-year follow-up, suggesting that the overall influence of HAART on the clinical course of HCV infection may be limited. The long-term effects of HAART on plasma HCV-RNA levels and transaminase values are summarized in table 1.…”

Section: Effect Of Haart On Hcv-related Liver Diseasementioning

confidence: 95%

Human Immunodeficiency Virus and Hepatitis C Virus Coinfection: Epidemiology, Natural History, Therapeutic Options and Clinical Management

et al. 2004

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Due to shared risk factors for transmission, coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is a very common event. The prevalence of HCV infection among HIV-positive patients averages about 35% in the United States and Europe, but in clinical populations where there is a great prevalence of intravenous drug use as a risk factor for acquiring HIV, this value may be as high as 80-90%. Several studies have confirmed that HIV coinfection accelerates the natural course of chronic hepatitis C and an increased risk of liver cirrhosis, hepatocellular carcinoma, and decompensated liver disease has been found in coinfected subjects. Other studies have shown an increased risk of progression to acquired immunodeficiency syndrome (AIDS) and AIDS-related death among HIV-HCV-positive persons, suggesting that HCV coinfection may accelerate the course of HIV disease. In addition, hepatitis C may affect the management of HIV infection, increasing the incidence of liver toxicity associated with the antiretroviral regimens. The optimal therapeutic approach to HCV infection in HIV coinfected patients is still uncertain, because of the complex pathogenesis of both infections, potential drugdrug interactions, and the poor literature and information available about safety and efficacy of an interferon (IFN) and ribavirin combination in this clinical population. Available data show that the sustained virological response rates in coinfected persons treated with standard IFN plus ribavirin range from 18-40%, and several studies with pegylated IFN plus ribavirin are ongoing.

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Evolution of Coinfection with Human Immunodeficiency Virus and Hepatitis C Virus in Patients Treated with Highly Active Antiretroviral Therapy

Cited by 49 publications

References 27 publications

Impact of Highly Active Antiretroviral Therapy and Immunologic Status on Hepatitis C Virus Quasispecies Diversity in Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patients

Impact of Highly Active Antiretroviral Therapy and Immunologic Status on Hepatitis C Virus Quasispecies Diversity in Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patients

Impact of highly active antiretroviral therapy on organ‐specific manifestations of HIV‐1 infection

Human Immunodeficiency Virus and Hepatitis C Virus Coinfection: Epidemiology, Natural History, Therapeutic Options and Clinical Management

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