The treatment of chronic hepatitis C virus infection in HIV co-infection

Abstract

Chronic HCV co-infection is present in up to one third of HIV-positive patients in Europe. In recent years, apart from the traditional transmission route of intravenous drug abuse, outbreaks of sexually transmitted acute HCV infections, mainly among HIV-positive men who have sex with men, have contributed to the overall disease burden.Because the natural course of HCV infection is substantially accelerated in HIV-co-infection, end-stage liver disease has become the most frequent cause of non-AIDS related death in this population. Therefore every HIV/HCV co-infected patient should be evaluated for possible anti-HCV therapy with the goal of reaching a sustained virological response and thus cure of hepatitis C infection. The standard of care for the treatment of chronic HCV infection in HIV-infected remains a pegylated interferon in combination with weight-adapted ribavirin.HAART should not be withheld from HCV co-infected patients due to concerns of drug related hepatotoxicity and in patients with reduced CD4-cell counts HAART should be started first. Under pegylated interferon and ribavirin combination therapy drug to drug interactions and cumulated toxicity between nucleoside analogues and anti-HCV therapy may be observed and concomitant didanosine use is contraindicated and zidovudine and stavudine should be avoided if possible.The development of new drugs for the treatment of chronic hepatitis C represents a promising perspective also for HIV positive patients. However, these substances will probably reach clinical routine for HIV patients later than HCV monoinfected patients. Therefore at present waiting for new drugs is not an alternative to a modern pegylated interferon/ribavirin therapy.

Effectiveness of direct-acting antivirals for hepatitis C virus infection in hepatitis C/HIV coinfected individuals

“…[ 11 – 13 ] In the interferon (IFN) treatment era, a minority of individuals could be treated due to the occurrence of significant adverse effects and low sustained virological response (SVR) rates. [ 12 , 14 , 15 ] With DAAs, especially IFN-free regimens, HCV therapy has been simplified and coinfected patients have achieved high cure rates. [ 11 , 12 ] Randomized clinical trials and real-life studies in different parts of the world have shown SVR rates greater than 90% in patients with HCV/HIV, similar to that reported for patients without HIV coinfection.…”

Acute Hepatitis C in an HIV-Infected patient: A Case Report and Review of Literature

“…The literature suggests, however, that people infected with HIV seem less likely to eradicate the infection spontaneously, compared to HIV negative individuals with reported clearance rates varying widely from 4-26 %. 3,42,[44][45][46][47][48][49][50] Because acute symptomatic hepatitis C infection is correlated to higher spontaneous viral clearance rates, this patient was closely observed for spontaneous viral clearance before treatment was considered. However, with a recurrent flare of his serum aminotransferase levels and HCV viral load 5 weeks after discharge, it was felt that his chance of achieving spontaneous viral clearance was low.…”

Severe anaemia related to oseltamivir during treatment of chronic hepatitis C: a new drug interaction?

“…Interactions between treatment for hepatitis C and other treatments are common and can worsen the side effects. In patients co‐infected with HCV and HIV, drug–drug interactions and cumulative toxicity between nucleoside analogues and anti‐HCV therapy have been described, including hepatic decompensation (sometimes fatal) in patients with cirrhosis [8].…”

“…Interactions with other therapies are also common and can worsen side effects. For example, cumulative toxicity and drug–drug interactions have been observed in patients receiving peginterferon alfa/ribavirin therapy for hepatitis C and nucleoside analogues for coinfection with human immunodeficiency virus (HIV) [8]. However, an extensive literature search did not identify reports of a drug interaction between ribavirin and the neuraminidase inhibitor oseltamivir.…”