Clinical

Hepatitis C virus clearance aids HIV therapy

Last Updated: 2007-09-14 12:33:21 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Successful treatment of hepatitis C virus (HCV) infection helps reduce the hepatotoxicity of antiretroviral drugs in patients with HIV, Spanish investigators report in the September 1st issue of The Journal of Infectious Diseases.

As senior researcher Dr. Pablo Barreiro told Reuters Health, "in patients with HIV infection, HCV is currently a major problem, probably the leading cause of morbidity and mortality."

However, he added, "Frequent drug toxicity is an important issue that makes patients reluctant to receive anti-HCV therapy."

To evaluate the effect of HCV treatment, the Dr. Barreiro of Hospital Carlos III in Madrid and associates retrospectively examined data on 132 co-infected men who had completed a full course of interferon therapy.

In all, 33% achieved a sustained virological response and 40% had advanced liver fibrosis. After a mean follow-up of 35 months, there were 49 episodes of liver toxicity.

The annual incidence of such events was significantly greater in those who did not have a sustained response (12.9%) than it was in those who did (3.1%). This was also true of patients with advanced fibrosis compared to those without (14.4% versus 7.6%).

Independent predictors of hepatotoxicity after interferon therapy were lack of a sustained virological response (odds ratio, 6.13), and the use of the dideoxynucleoside analogues, didanosine and stavudine (odds ratio, 3.59).

Conversely, a diminished risk of such events was seen with regimens containing protease inhibitors (odds ratio, 0.07) or efavirenz (odds ratio, 0.13).

"After HCV clearance," Dr. Barreiro continued, "a better control of HIV infection may be expected as liver toxicity of anti-HIV drugs is significantly reduced."

This, he pointed out, "is a novel argument to encourage treatment of HCV in people with HIV infection."

Dr. Barreiro also added that the liver toxicity of anti-HIV drugs is related to the degree of liver fibrosis as assessed by transient elastometry.

"This non-invasive technique," he concluded, "may be very helpful to choose the most appropriate anti-HIV drugs in patients with HIV and HCV coinfection."

J Infect Dis 2007;196:670-676.