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THE TREATMENT OF ACUTE HEPATITIS C INFECTION IN HIV-COINFECTED PATIENTS - A RETROSPECTIVE ANALYSIS OF 8 CASES IN A MULTICENTER SETTING
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Reported by Jules Levin
Rockstroh J.K. and colleagues. University of Bonn, Germany
Initiation of interferon therapy in the acute phase of hepatitis C infection considerably improved treatment response rates in HCV-monoinfected patients. We report on the efficacy of this treatment in HIV-coinfected patients.
8 HIV-positive patients with newly diagnosed HCV-infection and positive HCV-RNA, fulfilling 2/3 criteria within the preceding 4 months were located. 1) known or suspected exposure to HCV, 2) negative HCV-AB and documented seroconversion to positivity for HCV-AB, 3) acute hepatitis with a serum alanine transferase (ALT) level > 350 U/l with normal levels the year before infection.
7 male, 1 female, median age 36 years. Transmission risk factors were sexual (n=7) and intravenous drug abuse (n=1). At diagnosis 6/8 patients presented with clinical symptoms of hepatitis, 4/8 were icteric. All patients showed elevated liver enzymes with a median ALT of 471 U/l. Median HCV-RNA was 1017000 cop/ml, median CD4-count 514/µl, median HIV-RNA 3200 cop/ml. Patients carried HCV-genotype 1 (n=5), 2 (n=1) or 4 (n=2).
Patients were treated over 24 weeks with standard interferon (n=1), pegylated interferon (n=2) or pegylated interferon ribavirin combination therapy (n=5). Post-treatment response (undetectable HCV-RNA at end of treatment) was seen in 7/8 patients. Sustained treatment response rate (undetectable HCV-RNA 24 weeks after end of treatment) was seen in 6/8 patients. One patient continued treatment throughout week 48 due to slow virus elimination.
High rates of response have previously been seen in several studies of acute HCV in HIV negative individuals.
Authors concluded that with interferon +/- ribavirin initiated during the acute phase of HCV-infection in HIV-positive patients appears to be very effective. Further trials are needed, however, to validate these findings.
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