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Reuters Health Information (2005-08-31): Hepatitis C co-infection blunts HAART immune restoration in HIV Clinical
Hepatitis C co-infection blunts HAART immune restoration in HIV
Last Updated: 2005-08-31 13:35:29 -0400 (Reuters Health)
By Anne Harding
NEW YORK (Reuters Health) - Co-infection with hepatitis
C virus (HCV) impairs immune restoration in patients with HIV starting
highly active antiretroviral therapy (HAART), a new meta-analysis of
eight trials including 6,216 patients demonstrates.
After 48 weeks on HAART, the CD4 counts of patients co-infected with
HCV were 33.4 cells/mm3 lower than for those who did not have HCV
infection, Dr. Christopher F. Rowley of Beth Israel Deaconess Medical
Center in Boston and colleagues found.
Thirty percent of people with HIV are co-infected with HCV, Dr.
Rowley and his team note in their report in the Sept. 1 issue of
Clinical Infectious Diseases. Studies have suggested that HCV infection
may impair immune restoration by HAART, and there are questions as to
whether co-infected patients should begin HAART earlier for optimal
immune restoration as well as whether HCV should be eradicated before
HAART treatment begins.
"The real reason why we did the meta-analysis in the first place is
because it was an area of controversy and still remains an area of
controversy," Dr. Rowley told Reuters Health.
Hepatitis C treatment carries severe side effects, including
flu-like symptoms and depression, he noted. While frequently updated
guidelines are available on when HAART should begin, based on a
patient's CD4 count, there are no such guidelines for HCV treatment, he
added.
The current study was unable to determine whether lower CD4 counts
had any effect on virologic or clinical outcomes, the researchers note,
while the best time to start HCV treatment in co-infected patients also
remains unclear.
"Additional prospective studies need to be conducted to provide the
definitive answer to patients and clinicians, so that both infections
can be treated in the most effective manner," they conclude.
The next step, Dr. Rowley said, will be to determine if lower CD4 counts translate to worse virologic and clinical outcomes.
Clin Infect Dis 2005;41:713-720.
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