Prevalence and impact of GBV-C, SEN-V and HBV occult infections in HIV-HCV co-infected patients oil HCV therapy
ABSTRACT It has been suggested that, in HIV-HCV co-infected patients, co-infections with other viruses may affect the response to HCV therapy. We aimed to assess the prevalence of GBV-C, SEN-V and occult HBV infections, their impact on HCV and HIV infections and on the response to HCV therapy in HIV-HCV co-infected patients.
Three-hundred and sixty eight patients were tested before starting interferon-ribavirin for the presence of occult hepatitis B DNA, GBV-C RNA and SEN-V DNA by using real time PCR. Clinical, immunological, virological, histological characteristics and response to HCV therapy were compared according to the presence or not of each viral co-infection.
HBV DNA, GBV-C RNA and SEN-V DNA were found in 5 (1.4%, CI95%: 0.2-2.4%), 104 (29.9%, CI95%: 25.1-34.7%) and 209 patients (57.9%, CI95%: 52.8-63.0%), respectively. GBV-C positive patients had significantly higher CD4 count at baseline, during and after HCV therapy, even after stratification on antiretroviral treatment. No other significant difference was observed according to the presence or not of GBV-C or SEN-V co-infection, in particular regarding virological responses to HCV combination therapy.
There is no reason to withhold HCV therapy in HIV infected patients who have access to HAART, because of occult HBV, GBV-C or SEN-V co-infections.
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ABSTRACT: Since the pivotal trials conducted over the last few years which have used the combination of pegylated interferon along with fixed low doses (800mg/day) of ribavirin and have provided treatment for 12 months, regardless the kinetics of hepatitis C virus (HCV) viral load during therapy, great progress has been made in the treatment of chronic hepatitis C in HIV-infected patients. Results approaching those seen in HCV-monoinfected patients can be obtained with optimal dosages of ribavirin, extension of treatment beyond 48 weeks in the absence of rapid virologic response and/or in patients older than 40 years, with severe fibrosis (METAVIR score F3 or F4) and/or with high HCV viral load and with a better management of HIV treatment in order to avoid a negative interaction between HCV and HIV therapies (interaction between abacavir and ribavirin) and to improve the tolerance of HCV therapy (Didanosine should never be used with ribavirin, Zidovudine and Stavudine should be avoided when possible with ribavirin).Gastroentérologie Clinique et Biologique 03/2009; 33. DOI:10.1016/S0399-8320(09)72447-9 · 1.14 Impact Factor
- Clinical Infectious Diseases 09/2009; 49(4):623-5. DOI:10.1086/603558 · 9.42 Impact Factor
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ABSTRACT: Antiviral treatment for chronic hepatitis C may be less effective if patients are co-infected with human immunodeficiency virus (HIV). To assess the benefits and harms of antiviral treatment for chronic hepatitis C in patients with HIV. Trials were identified through manual and electronic searches in The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded. The last search was May 2009. Randomised trials comparing at least 12 weeks of any anti-HCV treatment versus another treatment regimen or no treatment. Included patients had chronic hepatitis C and stable HIV irrespective of previous antiviral therapy. Data extraction and assessment of risk of bias were done in duplicate. Analysis was by intention-to-treat. Fourteen trials were included. None of the included 2269 patients were previously treated for chronic hepatitis C. Peginterferon (either 2a, 180 microgram, or 2b, 1.5 microgram/kg, once weekly) plus ribavirin was more effective in achieving end of treatment and sustained virological response compared with interferon plus ribavirin (5 trials, 1340 patients) or peginterferon (2 trials, 714 patients). The benefit of peginterferon plus ribavirin was seen irrespective of HCV genotype although patients with genotype 1 or 4 had lower response rates (27%) than patients with genotype 2 or 3 (56%). The remaining trials compared different treatment regimens in patients who were treatment naive or had no virological response after three months of treatment, but overall they had not enough power to show any effect of increasing the dose of interferon or adding both amantadine or ribavirin. The overall mortality was 23/2111 patients with no significant differences between treatment regimens. Treatment increased the risk of adverse events including anaemia and flu-like symptoms, and several serious adverse events occurred including fatal lactic acidosis, liver failure, and suicide due to depression. Peginterferon plus ribavirin may be considered a treatment for patients with chronic hepatitis C and stable HIV who have not received treatment for hepatitis C as the intervention may clear the blood of HCV RNA. Supporting evidence comes mainly from the analysis of this non-validated surrogate outcome assessed in comparisons against other antiviral treatments. There is no evidence on treatment of patients who have relapsed or did not respond to previous therapy. Careful monitoring of adverse events is warranted.Cochrane database of systematic reviews (Online) 01/2010; DOI:10.1002/14651858.CD004888.pub2 · 5.94 Impact Factor