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IL-2 & HCV/HIV Coinfection
Reported by Jules Levin
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There have been several small studies suggesting that perhaps IL-2 could have a beneficial effect on HCV, ALT and viral load. But the results from these studies have been mixed, with some showing benefit and others not showing benefit. We know from numerous studies that IL-2 can raise CD4 count significantly. The clinical benefit of these CD4 increases compared to CD4 increases from HAART are under study now, but preliminary study results suggest that IL-2 induced CD4 increases does have clinical benefit.
A Spanish research group from Madrid reported at Retrovirus. 17 HCV/HIV coinfected patients were treated with IL-2. All patients had detectable HCV viral load before starting IL-2. After starting IL-2 patients were followed every 8 weeks during the first several IL-2 treatments for ALT, AST, and total bilirubin. Patients had their HCV viral load checked after receiving each IL-2 treatment cycle.
15 study patients were men. The median CD4 nadir (lowest CD4 count ever reached) was 53, and all had undetectable HIV viral load. The patients were on HAART for an average of 22 months. And the average baseline CD4 count was 170. 12 patients were considered responders to the IL-2 as their CD4 count increased >50% after receiving the third IL-2 treatment. The baseline ALT & AST was >2 times above the upper limit of normal for 60% of patients before receiving any IL-2. The average HCV viral load was 800,000 IU/ml before receiving any IL-2. After the first 3 IL-2 cycles of treatment, there was no benefit seen for ALT or AST, no changes in bilirubin, and no significant decline in HCV viral load. The authors concluded that although IL-2 did not improve HCV IL-2 did not appear to cause hepatoxicity, and may be a safe therapy for HIV for coinfected patients.
If safe, IL-2 may offer a potential strategy for coinfected patients with low CD4s despite HAART. It is generally accepted that coinfected patients with low CD4s, perhaps <200-300, may not respond well to interferon+ribavirin, the therapy for HCV. So, if HAART is unable to raise CD4s for these patients perhaps IL-2 therapy can be helpful.
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