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Rapid Screening of HIV Reverse Transcriptase and Integrase Inhibitors
05:46

Rapid Screening of HIV Reverse Transcriptase and Integrase Inhibitors

Published on: April 9, 2014

Current management of hepatitis C virus infection in patients with HIV co-infection

Mark S Sulkowski1

  • 1Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA. msulkowski@jhmi.edu

The Journal of Infectious Diseases
|February 8, 2013
PubMed

Insights

New protease inhibitor (PI) regimens offer improved hepatitis C virus (HCV) eradication rates for patients coinfected with human immunodeficiency virus (HIV). These PI-based treatments show promise for managing HCV genotype 1 in carefully selected HIV-infected individuals.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Pharmacology

Background:

  • Hepatitis C virus (HCV) coinfection is common in human immunodeficiency virus (HIV)-infected patients, particularly among those with a history of injection drug use.
  • Sexual transmission of HCV is increasingly recognized in HIV-infected men who have sex with men (MSM).
  • Liver disease from HCV infection is a growing concern for coinfected patients due to improved HIV/AIDS survival rates, while HCV treatment options remained limited.

Purpose of the Study:

  • To evaluate the efficacy and safety of novel HCV NS3/4A protease inhibitors (PIs) in combination with pegylated interferon alfa (PegIFN) and ribavirin (RBV) for treating HCV genotype 1 in HIV-coinfected patients.
  • To address questions regarding drug interactions between HCV PIs and antiretroviral drugs.
  • To determine if these new regimens improve HCV eradication rates compared to standard PegIFN/RBV therapy.

Main Methods:

  • Review of drug-interaction studies and data from two small, phase II clinical trials.
  • Assessment of treatment initiation and success rates in HIV/HCV-coinfected patients.
  • Evaluation of toxicity and pharmacologic interactions with antiretroviral medications.

Main Results:

  • HCV PI-based regimens (telaprevir and boceprevir) in combination with PegIFN/RBV show potential for higher HCV eradication rates in HIV/HCV-coinfected patients.
  • These regimens demonstrate manageable toxicity and predictable pharmacologic interactions with antiretroviral drugs.
  • The effectiveness of standard PegIFN/RBV treatment in this population has been historically disappointing.

Conclusions:

  • HCV protease inhibitor-based regimens are emerging as a standard of care for HCV genotype 1 treatment in select HIV-infected patients.
  • These novel regimens offer improved outcomes for HCV eradication in the context of HIV coinfection.
  • Careful patient selection and management of drug interactions are crucial for successful treatment.

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