Response‐Guided Therapy for Chronic Hepatitis C Virus Infection in Patients Coinfected with HIV: A Pilot Trial

Abstract

A response-guide therapy is feasible and may be useful to optimize the individual outcome of HCV treatment in patients coinfected with HIV.

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

“…In the AIDS Pegasys Ribavirin International Co-infection Trial (APRICOT) study, patients treated with peginterferon and ribavirin had a mean CD4 count decrease of 140 cells/mL [196] and there have been previous case reports of interferon-treated patients developing opportunistic infections following an interferon-associated CD4 count decline. Ideally, therefore, patients should have a CD4 count of at least 200 cells/mL and undetectable HIV RNA.…”

“…(b) There is less chance of an SVR [196,201,202,205]. (c) The patient is at risk of varices and HCC, and should be screened for both.…”

“…Overall, the SVR rates in coinfected patients are approximately 60% of those seen in HCV-monoinfected patients [194][195][196][200][201][202]205]. It is reasonable, therefore, to treat patients with genotype 2 or 3 infection without performing a baseline liver biopsy if there is no evidence of advanced liver disease clinically, or by using noninvasive tests/ biomarkers.…”

“…It is reasonable, therefore, to treat patients with genotype 2 or 3 infection without performing a baseline liver biopsy if there is no evidence of advanced liver disease clinically, or by using noninvasive tests/ biomarkers. In those with genotype 1 or 4 infection, or where there is clinical concern regarding co-existent liver disease such as haemochromatosis, or alcohol-related or other liver disease, a biopsy can be helpful in staging the liver disease(s) and determining the need for HCV therapy [194][195][196][200][201][202]205,206]. In those individuals refusing liver biopsy, noninvasive tests/biomarkers such as hepatic elastography can be useful alternate techniques to identify those with earlier stages of fibrosis not requiring therapy (see General section).…”

“…A team approach is vital to manage HIV/HCV-coinfected patients with access to experienced physicians and trained specialist nurses with knowledge of coinfection to support and monitor the patients while on therapy [194][195][196][200][201][202]205,206].…”