Hepatitis C Viral Kinetics During Treatment With Peg IFN-alpha-2b in HIV/HCV Coinfected Patients as a Function of Baseline CD4+ T-Cell Counts

Abstract

Background HIV/HCV co-infected patients are known to have lower sustained viral response (SVR) rates than HCV mono-infected patients. However, the role of CD4+ T-cell counts on viral kinetics and outcome is not fully understood. Methods HCV-RNA kinetics (bDNA v3, LD=615 IU/ml) was analyzed in 32 HIV/HCV co-infected persons treated with Pegylated interferon-α2b (1.5 μg/kg weekly) and ribavirin (1–1.2 g daily) for 48 weeks and compared with results obtained from 12 HCV monoinfected patients treated with the same regimen. Results Baseline CD4+ T cell counts ≥450cells/mm3 were significantly (P<0.002) associated with SVR in co-infected genotype 1 patients. First phase decline was significantly lower among patients with low as compared to high CD4 counts (P<0.03) and among co-infected compared to mono-infected patients (P<0.002). Second phase decline slope showed a similar trend for co-infected patients. Conclusions Low baseline CD4+ T cell count is associated with slower HCV viral kinetics and worse response to treatment among HIV co-infected patients, suggesting HCV treatment response depends on immune status. HCV genotype 1 co-infected patients have slower first phase viral kinetics than HCV mono-infected patients. First-phase viral decline (>1.0 log) and second-phase viral decline slope (>0.3 log/week) are excellent predictors of SVR for co-infected patients.

Seroprevalence of Hepatitis B and Hepatitis C Virus in HIV/AIDS Patients at Gaziantep University

“…Ko-enfekte hastalarda ART ile aminotransferaz enzimlerinde yükselme görülebilmektedir, ancak uzun dönemde ART'nin kronik HCV kliniğini iyileştirdiği gösterilmiştir [24,25] . CD4 T-lenfosit düzeyi <200 hücre/mm 3 olan hastalarda öncelikle ART'nin başlanması ve CD4 T-lenfosit düzeyi yükseldikten sonra kronik HCV enfeksiyonu tedavisinin başlanması önerilmektedir [26,27] . Hepatit C virüs RNA'sı (+) olan kompanse sirotik olguya tanı anındaki CD4 T-lenfosit sayısı 150 hücre/mm 3 olduğundan önce ART başlandı, CD4 T-lenfosit düzeyi arttıktan sonra karaciğer biyopsisi yapılmadan kronik HCV tedavisi planlandı.…”

HIV/HCV Koenfeksiyonu: Olgu Sunumu

“…CD4 T-lenfosit sayısı düşük (<200 hücre/mm3) olan hastalarda öncelikle ART'nin başlanması ve HCV tedavisinin CD4 T sayısı yükselene dek ertelenmesi önerilmektedir (20)(21)(22). Bunun nedenleri olarak; CD4 hücre sayısının düşük olmasının karaciğer hastalığının progresyonunu hızlandırması ve CD4 T-lenfosit sayısın <200 hücre/mm3 iken HCV tedavi deneyiminin az olması gösterilmektedir.…”

British HIV Association guidelines for the management of hepatitis viruses in adults infected with HIV 2013

“…Combining TDF with either FTC or 3TC provides benefits, with improved HBV DNA level responses. Previous RCT or cohort analyses have not reported the superior efficacy of dual therapy over TDF monotherapy in long-term HBV suppression in coinfection [19,57,58], although this has recently been reported [59] and additionally has been demonstrated in monoinfection for patients in the immune tolerant phase [60]. In a mouse model, TDF/FTC combination therapy provides more effective HBV suppression than therapy with either drug alone [61].…”

“…Both tests can be considered accurate in identifying those with cirrhosis (AUROC > 0.80), but are less successful than in HCV monoinfection in the identification of significant and severe fibrosis (AUROC < 0.80) [56]. The Forns Index has been validated in HCV/HIV infection [58] and has a high degree of concordance with transient elastography in the identification of advanced fibrosis/cirrhosis. Of the commercially available tests, Fibrometer and FibroTest have both been validated in the HIV coinfection settings and perform well in terms of identification of significant fibrosis (AUROC 0.85 and 0.82 respectively) [59].…”

“…Dual therapy may theoretically protect against the development of resistance and reactivation. Although TDF phenotypic resistance has not been documented in coinfected patients with up to 5 years of follow-up, a mutation (A194T) has been identified in individuals treated under suboptimal viral control which in vitro imparts partial TDF resistance [58].…”