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The treatment of chronic hepatitis C virus infection in HIV co-infection.

Vogel M, Rockstroh JK - Eur. J. Med. Res. (2009)

Bottom Line: Under pegylated interferon and ribavirin combination therapy drug to drug interactions and cumulated toxicity between nucleoside analogues and anti-HCV therapy may be observed and concomitant didanosine use is contraindicated and zidovudine and stavudine should be avoided if possible. - The development of new drugs for the treatment of chronic hepatitis C represents a promising perspective also for HIV positive patients.However, these substances will probably reach clinical routine for HIV patients later than HCV monoinfected patients.Therefore at present waiting for new drugs is not an alternative to a modern pegylated interferon/ribavirin therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine I, Bonn university, Bonn, Germany.

ABSTRACT
Chronic HCV co-infection is present in up to one third of HIV-positive patients in Europe. In recent years, apart from the traditional transmission route of intravenous drug abuse, outbreaks of sexually transmitted acute HCV infections, mainly among HIV-positive men who have sex with men, have contributed to the overall disease burden. - Because the natural course of HCV infection is substantially accelerated in HIV-co-infection, end-stage liver disease has become the most frequent cause of non-AIDS related death in this population. Therefore every HIV/HCV co-infected patient should be evaluated for possible anti-HCV therapy with the goal of reaching a sustained virological response and thus cure of hepatitis C infection. The standard of care for the treatment of chronic HCV infection in HIV-infected remains a pegylated interferon in combination with weight-adapted ribavirin. - HAART should not be withheld from HCV co-infected patients due to concerns of drug related hepatotoxicity and in patients with reduced CD4-cell counts HAART should be started first. Under pegylated interferon and ribavirin combination therapy drug to drug interactions and cumulated toxicity between nucleoside analogues and anti-HCV therapy may be observed and concomitant didanosine use is contraindicated and zidovudine and stavudine should be avoided if possible. - The development of new drugs for the treatment of chronic hepatitis C represents a promising perspective also for HIV positive patients. However, these substances will probably reach clinical routine for HIV patients later than HCV monoinfected patients. Therefore at present waiting for new drugs is not an alternative to a modern pegylated interferon/ribavirin therapy.

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Guidelines of the European AIDS Society (EACS) for the treatment of chronic hepatitis C infection in HIV/HCV coinfected individuals. W = week, neg = negative, pos = positive, G = HCV-genotype.
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Figure 1: Guidelines of the European AIDS Society (EACS) for the treatment of chronic hepatitis C infection in HIV/HCV coinfected individuals. W = week, neg = negative, pos = positive, G = HCV-genotype.

Mentions: The duration of treatment should be individualized according to HCV genotype, baseline HCV viral load, and response to treatment (Figure 1, [29]). Based on the data from the PRESCO trial patients with genotype 1 and 4 infections should be treated for 48 weeks in case of a rapid HCV-RNA clearance below the level of detection at week 4 (rapid virological response). In all other cases treatment should be prolonged to 72 weeks [54]. On the other side, in patients with a rapid virological response, i.e. a negative HCV-RNA at week 4 and a genotype 2 or 3 infection, the overall treatment course may be reduced to 24 weeks. However, this should be only done in patients with a low baseline HCV viral load < 400 000 I.U./ml and only minimal liver fibrosis [55]. All other patients with a genotype 2 or 3 infection should be treated for 48 weeks. Treatment may be stopped if insufficient virological response is observed. Thus, if the decay of HCVRNA is less than 2 log10 at week 12 or HCV-RNA is still positive at week 24 treatment should be stopped. Under these treatment modalities, the response rates in HIV/HCV coinfected patients have significantly improved over the years, closing the gaps between HCV monoinfected and HIV/HCV coinfected patients (Table 2). Currently in HIV/HCV coinfected patients a sustained virological response, i.e. a negative HCV-RNA 24 weeks after stop of treatment, is observed in genotype 1 or 4 infections in about 35% and in genotype 2 and 3 infections in about 70% of patients [56].


The treatment of chronic hepatitis C virus infection in HIV co-infection.

Vogel M, Rockstroh JK - Eur. J. Med. Res. (2009)

Guidelines of the European AIDS Society (EACS) for the treatment of chronic hepatitis C infection in HIV/HCV coinfected individuals. W = week, neg = negative, pos = positive, G = HCV-genotype.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3351935&req=5

Figure 1: Guidelines of the European AIDS Society (EACS) for the treatment of chronic hepatitis C infection in HIV/HCV coinfected individuals. W = week, neg = negative, pos = positive, G = HCV-genotype.
Mentions: The duration of treatment should be individualized according to HCV genotype, baseline HCV viral load, and response to treatment (Figure 1, [29]). Based on the data from the PRESCO trial patients with genotype 1 and 4 infections should be treated for 48 weeks in case of a rapid HCV-RNA clearance below the level of detection at week 4 (rapid virological response). In all other cases treatment should be prolonged to 72 weeks [54]. On the other side, in patients with a rapid virological response, i.e. a negative HCV-RNA at week 4 and a genotype 2 or 3 infection, the overall treatment course may be reduced to 24 weeks. However, this should be only done in patients with a low baseline HCV viral load < 400 000 I.U./ml and only minimal liver fibrosis [55]. All other patients with a genotype 2 or 3 infection should be treated for 48 weeks. Treatment may be stopped if insufficient virological response is observed. Thus, if the decay of HCVRNA is less than 2 log10 at week 12 or HCV-RNA is still positive at week 24 treatment should be stopped. Under these treatment modalities, the response rates in HIV/HCV coinfected patients have significantly improved over the years, closing the gaps between HCV monoinfected and HIV/HCV coinfected patients (Table 2). Currently in HIV/HCV coinfected patients a sustained virological response, i.e. a negative HCV-RNA 24 weeks after stop of treatment, is observed in genotype 1 or 4 infections in about 35% and in genotype 2 and 3 infections in about 70% of patients [56].

Bottom Line: Under pegylated interferon and ribavirin combination therapy drug to drug interactions and cumulated toxicity between nucleoside analogues and anti-HCV therapy may be observed and concomitant didanosine use is contraindicated and zidovudine and stavudine should be avoided if possible. - The development of new drugs for the treatment of chronic hepatitis C represents a promising perspective also for HIV positive patients.However, these substances will probably reach clinical routine for HIV patients later than HCV monoinfected patients.Therefore at present waiting for new drugs is not an alternative to a modern pegylated interferon/ribavirin therapy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Internal Medicine I, Bonn university, Bonn, Germany.

ABSTRACT
Chronic HCV co-infection is present in up to one third of HIV-positive patients in Europe. In recent years, apart from the traditional transmission route of intravenous drug abuse, outbreaks of sexually transmitted acute HCV infections, mainly among HIV-positive men who have sex with men, have contributed to the overall disease burden. - Because the natural course of HCV infection is substantially accelerated in HIV-co-infection, end-stage liver disease has become the most frequent cause of non-AIDS related death in this population. Therefore every HIV/HCV co-infected patient should be evaluated for possible anti-HCV therapy with the goal of reaching a sustained virological response and thus cure of hepatitis C infection. The standard of care for the treatment of chronic HCV infection in HIV-infected remains a pegylated interferon in combination with weight-adapted ribavirin. - HAART should not be withheld from HCV co-infected patients due to concerns of drug related hepatotoxicity and in patients with reduced CD4-cell counts HAART should be started first. Under pegylated interferon and ribavirin combination therapy drug to drug interactions and cumulated toxicity between nucleoside analogues and anti-HCV therapy may be observed and concomitant didanosine use is contraindicated and zidovudine and stavudine should be avoided if possible. - The development of new drugs for the treatment of chronic hepatitis C represents a promising perspective also for HIV positive patients. However, these substances will probably reach clinical routine for HIV patients later than HCV monoinfected patients. Therefore at present waiting for new drugs is not an alternative to a modern pegylated interferon/ribavirin therapy.

Show MeSH
Related in: MedlinePlus