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Published on: July 16, 2012
[HIV and hepatitis C virus coinfection]
P Cacoub1, D Sène, E Rosenthal
1Service de Médecine Interne, AP HP, Hôpital La Pitié Salpêtrière, 83, bd de l'Hôpital, 7 5651 Paris cedex 13, France. patrice.cacoub@psl.aphp.fr
Insights
Managing chronic hepatitis C in patients with human immunodeficiency virus (HIV) is complex. Treatment success depends on viral factors, host characteristics, and early response, with significant tolerability issues noted.
Area of Science:
- Hepatology
- Infectious Diseases
- Virology
Context:
- Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) coinfection presents unique clinical challenges.
- Co-infected patients face accelerated liver disease progression and potential antiretroviral drug hepatotoxicity.
- Managing these coinfections requires careful consideration of numerous viral and host factors.
Purpose:
- To review the challenges and outcomes of treating chronic hepatitis C in HIV-coinfected patients.
- To analyze the efficacy of peginterferon alfa plus ribavirin in this population.
- To highlight predictors of treatment success and tolerability issues.
Summary:
- Treatment outcomes for chronic hepatitis C in HIV-coinfected patients receiving peginterferon alfa plus ribavirin vary, with sustained virologic response rates between 27% and 55% across five trials.
- Early virologic response is a key predictor of sustained virologic response.
- Hematologic tolerability issues are common, impacting treatment adherence and outcomes.
Impact:
- Effective management strategies are crucial for improving the long-term prognosis of HIV-HCV coinfected individuals.
- Understanding patient and viral factors is essential for optimizing treatment regimens.
- Further research is needed to enhance treatment efficacy and minimize adverse events in this vulnerable population.
Abstract:
Managing chronic hepatitis C in patients coinfected with the human immunodeficiency virus is a significant challenge. Treatment is influenced by a number of viral and host characteristics, including hepatitis C virus genotype, baseline viremia, and adherence to medication. Accelerated progression of liver disease, immunodeficiency, and hepatotoxicity of antiretroviral drugs are additional concerns in coinfected patients. According to the results of 5 randomized clinical trials, 27 %-55 % of coinfected patients who receive therapy with peginterferon alfa plus ribavirin attain sustained virologic response. These studies also confirm the importance of early virologic response as a predictor of treatment outcome and reveal the considerable proportion of patients who experience hematologic tolerability issues. Effective management strategies that encompass patient and viral factors are necessary to improve the long-term outlook for coinfected patients.
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