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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
Rochstroh and colleagues from the University of Bonn in Germany reported at
the 9th European AIDS Conference (November, 2003, Warsaw, Poland) on the
treatment of hepatitis C during the acute phase of infection. Several studies over the past few years have reported high profile results finding that if you can identify acutely infected individuals, which is very difficult, they can be
treated with much higher success rates than treatment for chronically infected
individuals. This study isthe first I know of to look at HCV/HIV coinfected
individuals identified & treated with interferon during the acute phase of HCV infection.
Initiation of interferon therapy in the acute phase of hepatitis C infection
(during the first several monthsafter 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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