Management Complexities of HIV/Hepatitis C Virus Coinfection in the Twenty-First Century

Re, Vincent Lo; Kostman, Jay R.; Amorosa, Valerianna

doi:10.1016/j.cld.2008.03.009

Cited by 29 publications

(15 citation statements)

References 138 publications

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“…These include non-HIV related serious adverse events (SAEs), co-morbidities such as viral hepatitis, cardiovascular and metabolic diseases, and HRQoL measures [20], [21], [22], [23].…”

Section: Introductionmentioning

confidence: 99%

Results of Antiretroviral Treatment Interruption and Intensification in Advanced Multi-Drug Resistant HIV Infection from the OPTIMA Trial

et al. 2011

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BackgroundGuidance is needed on best medical management for advanced HIV disease with multidrug resistance (MDR) and limited retreatment options. We assessed two novel antiretroviral (ARV) treatment approaches in this setting.Methods and FindingsWe conducted a 2×2 factorial randomized open label controlled trial in patients with a CD4 count ≤300 cells/µl who had ARV treatment (ART) failure requiring retreatment, to two options (a) re-treatment with either standard (≤4 ARVs) or intensive (≥5 ARVs) ART and b) either treatment starting immediately or after a 12-week monitored ART interruption. Primary outcome was time to developing a first AIDS-defining event (ADE) or death from any cause. Analysis was by intention to treat. From 2001 to 2006, 368 patients were randomized. At baseline, mean age was 48 years, 2% were women, median CD4 count was 106/µl, mean viral load was 4.74 log10 copies/ml, and 59% had a prior AIDS diagnosis. Median follow-up was 4.0 years in 1249 person-years of observation. There were no statistically significant differences in the primary composite outcome of ADE or death between re-treatment options of standard versus intensive ART (hazard ratio 1.17; CI 0.86–1.59), or between immediate retreatment initiation versus interruption before re-treatment (hazard ratio 0.93; CI 0.68–1.30), or in the rate of non-HIV associated serious adverse events between re-treatment options.ConclusionsWe did not observe clinical benefit or harm assessed by the primary outcome in this largest and longest trial exploring both ART interruption and intensification in advanced MDR HIV infection with poor retreatment options.Trial RegistrationClinicaltrials.gov NCT00050089

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“…These include non-HIV related serious adverse events (SAEs), co-morbidities such as viral hepatitis, cardiovascular and metabolic diseases, and HRQoL measures [20], [21], [22], [23].…”

Section: Introductionmentioning

confidence: 99%

Results of Antiretroviral Treatment Interruption and Intensification in Advanced Multi-Drug Resistant HIV Infection from the OPTIMA Trial

et al. 2011

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“…The presence of HCV/HIV co‐infection can influence the natural history of chronic Hepatitis C [4]. Co‐infection with HIV may accelerate the progression of liver disease in patients with underlying HCV [5–7]. On the other hand, it is yet unclear to what extent underlying HCV affects outcomes in patients with HIV [8–11], with many authors finding comparable or indeed superior survival in the co‐infected patients compared to those with isolated HIV infection [8,10,11].…”

Section: Introductionmentioning

confidence: 99%

Hepatitis C/HIV co-infection is associated with higher mortality in hospitalized patients with Hepatitis C or HIV

Ananthakrishnan¹,

McGinley²,

Fangman

et al. 2009

Journal of Viral Hepatitis

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Up to 10% of all patients with Hepatitis C virus (HCV) infection are co-infected with human immunodeficiency virus (HIV); 25-30% of HIV patients are co-infected with HCV. The aim of this study was to examine the association of HCV/HIV co-infection with outcomes of hospitalized patients compared to those with HCV or HIV monoinfection. Using the 2006 Nationwide Inpatient Sample, patients with HCV or HIV monoinfection or HCV/HIV co-infection were identified using ICD-9-CM codes. We compared liver-related and infection-related admission between the three groups of patients. Multivariate logistic regression was performed to identify independent predictors of in-hospital mortality. A total of 474,843 discharges with HCV monoinfection, 206,758 with HIV monoinfection and 56,304 with HCV/HIV co-infection were included. Liver-related admissions were more common in co-infected patients (15.4%) compared to those with HIV monoinfection (3.3%, P < 0.001). Primary infectious hospitalizations were more common in HIV monoinfection (33.9%) compared to co-infected patients (26%, P < 0.001). HCV/HIV co-infection was associated with higher mortality compared to HCV monoinfection (OR 1.41, 95% CI 1.20-1.65) but not when compared to monoinfected-HIV patients. HCV-associated cirrhosis or complications thereof conferred four times greater mortality risk in patients with HIV (OR 3.96, 95% CI 3.29-4.79). The rate of hospitalization for HCV/HIV co-infected patients (23.5%) was significantly higher than those with HCV (14.8%) or HIV (19.9%) (P < 0.001). HCV/HIV co-infection is associated with significantly higher rates of hospitalization and is a risk factor for in-hospital mortality compared to patients with isolated HCV.

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“…The occurrence of HIV-related thrombocytopenia in HCV-co-infected patients may be aggravated due to the suppression of BM production by HCV itself or interferon antiviral treatment [67,68]. …”

Section: Mechanisms Of Hiv-related Thrombocytopeniamentioning

confidence: 99%

An Overview of the Mechanisms of HIV-Related Thrombocytopenia

Passos

Treitinger²,

Spada³

2010

Acta Haematol

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The first thrombocytopenia cases related to the human immunodeficiency virus (HIV) were described even before its isolation in 1983. Subsequently, multiple mechanisms have been proposed to elucidate the etiology of thrombocytopenia. In addition to other types of cytopenia affecting patients with HIV, thrombocytopenia is observed in about 10–50% HIV patients as one of the first clinical signs of infection. Thus, in this review we aim to summarize the mechanisms proposed for thrombocytopenia since the discovery of HIV, and especially the innovations in the field in recent years. Among the different mechanisms suggested for HIV-related thrombocytopenia, there is emphasis on the accelerated destruction of platelets (PLTs) due to the action of immune complexes, and the presence of anti-PLT and anti-HIV antibodies that cross-react with the PLT membrane. There are also secondary causes of thrombocytopenia, such as the effect of drugs and opportunistic diseases associated with HIV.

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Management Complexities of HIV/Hepatitis C Virus Coinfection in the Twenty-First Century

Cited by 29 publications

References 138 publications

Results of Antiretroviral Treatment Interruption and Intensification in Advanced Multi-Drug Resistant HIV Infection from the OPTIMA Trial

Results of Antiretroviral Treatment Interruption and Intensification in Advanced Multi-Drug Resistant HIV Infection from the OPTIMA Trial

Hepatitis C/HIV co-infection is associated with higher mortality in hospitalized patients with Hepatitis C or HIV

An Overview of the Mechanisms of HIV-Related Thrombocytopenia

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