Clinical

GB virus C may reduce severity of HCV-related liver disease in HIV patients

Last Updated: 2008-01-09 15:33:30 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - In patients coinfected with HIV and hepatitis C virus (HCV), the presence of GB virus C (GBV-C) is associated with a reduction in liver disease severity, according to a report in the December issue of Gastroenterology.

"GBV-C was associated with a significant reduction in HCV-related liver disease in the setting of HCV/HIV co-infection," Dr. Mark D. Berzsenyi from Alfred Hospital, Prahran, Victoria, Australia told Reuters Health. "If the mechanism can clearly be identified and reproduced in vitro, perhaps in the future this could form the basis of a new therapeutic approach."

Dr. Berzsenyi and colleagues assessed the influence of GBV-C infection on liver disease in 158 patients coinfected with HCV and HIV.

There were no significant differences in HIV viral load, frequency of AIDS diagnosis, or time from HIV diagnosis to AIDS between patients with GBV-C and without GBV-C, the authors report, but CD4 counts were insignificantly higher in the active GBV-C group.

Active GBV-C viremia was associated with significant reductions in cirrhosis and decompensated cirrhosis, the report indicates, as was persistent infection with GBV-C RNA.

Along with greater CD4 count at follow-up, active GBV-C viremia was significantly associated with compensated/decompensated cirrhosis-free survival, the researchers note, but there was no association between active GBV-C and liver-related death or overall survival.

"GBV-C is thought to lead to upregulation of T-helper 1 cytokines and down-regulation of T-helper 2 cytokines, leading to an immunologic profile that is associated with an improved outcome for HIV/AIDS," the investigators say.

"Further work is planned to prospectively confirm this study with a multi-centered study," Dr. Berzsenyi said. "As well, we are currently looking at the mechanism of action and intend to expand on this work. Part of this work would be looking at the effect of GBV-C in the setting of HCV/HIV infected patients being considered for combination therapy."

"Future studies on the effect of GBV-C on HCV-related pathogenesis should include examination of the effect of GBV-C on cohorts with HCV-related and other forms of liver disease, and in HIV-infected and uninfected cohorts," Dr. Jack Stapleton from The University of Iowa and Iowa City VA Medical Center writes in a related editorial.

"This will allow determination as to whether the effect is restricted to HIV-infected people, and if this result is specific for HCV-induced hepatic injury," he explains.

Gastroenterology 2007;133:1821-1830,2042-2045.