HIV and Hepatitis C:
Interferon treatment beats HAART
With reduced morbidity and mortality due to
highly active antiretroviral therapy (HAART), attention has turned to the control of
co-existing infections including hepatitis C virus (HCV). According to data presented
here, concomitant HCV infection accelerates progression of HIV disease and is not
alleviated by HAART.
About one in 10 HIV-infected persons is
co-infected with HCV, says Margaret Hoffman-Terry, medical director of the HIV ambulatory
clinic at Lehigh Valley Hospital in the US. Hoffman-Terry evaluated disease progression in
100 HIV-infected persons, primarily intravenous drug users, half of whom were co-infected
with HCV. All patients were taking similar antiretroviral regimens. Decreasing CD4 counts
and increasing HIV viral loads occurred in significantly more patients infected with both
viruses. "The impact of HCV co-infection on HIV disease necessitates more aggressive
treatment of HCV," Hoffman-Terry concludes.
HAART does not meet this goal, according to work
presented by Olivier Rutschmann, of the University Hospital, Geneva. Rutschmann
prospectively followed 28 persons co-infected with HIV and HCV treated with regimens
containing a protease inhibitor (PI). As expected, HIV RNA levels decreased and CD4
numbers increased. But, says Rutschmann, "After two years of follow-up, HCV viremia
remains stable at the baseline value. This means that HAART is not harmful for patients
with HCV and HIV co-infection, but it is not sufficient to control HCV replication." |
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However, a prospective trial in Spain showed that
alpha interferon (a-IFN) can control HCV. Javier Garcia-Samaniego, of the Institute Carlos
III, Madrid, reported on 107 patients with chronic hepatitis C, 80 of whom were
HIV-positive. After one year of a-IFN therapy, the hepatitis response rate was equivalent
in HIV-positive and HIV-negative persons. It was higher in those with CD4 counts above 500
at 42%, than in those with CD4 counts between 200 and 500 at 20%. After 3.4 years, HCV RNA
remained undetectable in 12 HIV-positive individuals who had an early response.
Garcia-Samaniego recommends IFN treatment in co-infected persons whose immunodeficiency is
not severe. Rutschmann agrees that "Interferon is helpful in some patients, but we
need a [protease inhibitor] for HCV, too."
this story can also be found on page 8 of The Bridge, the onsite print
newspaper
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