Epidemiology

Hepatitis C coinfection increases adverse reactions to HAART

Last Updated: 2010-05-25 14:11:21 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Hepatitis C virus (HCV) coinfection increases the risk for adverse reactions to highly active antiretroviral therapy (HAART) in HIV patients, new research from China shows.

HCV did not affect patients' immunologic and virologic responses, according to the April 26 online report in the Journal of Acquired Immune Deficiency Syndromes.

"Successful treatment of hepatitis C should perhaps be completed before commencing HAART," say lead author Dr. Guo Fuping and colleagues from Peking Union Medical College Hospital, in Beijing.

The investigators had studied the influence of HCV coinfection on antiretroviral potency, immunologic reconstitution, and adverse events in 175 Chinese HIV-positive patients receiving nevirapine-containing HAART.

Fifty-eight patients (33.1%) had antibodies to HCV, including 34 (19.4%) who were positive for HCV RNA.

During 100 weeks of HAART, the magnitude of the decline in HIV-1 viral load was similar in all three groups (HCV negative, HCV antibody positive but RNA negative, and HCV antibody and RNA positive).

Viral response rates were also similar, with no differences in the percentages of patients who achieved plasma viral loads of less than 400 copies/mL or less than 50 copies/mL.

Similarly, there were no significant differences between the groups in CD4+ or CD8+ T-cell counts, or in CD4/CD8 ratios.

But the incidence of grade 2 rash was significantly higher in the HCV RNA-positive group (9/34, 26.5%) than in the anti-HCV negative group (12/117, 10.3%). In addition, HCV RNA-positive patients had a significantly higher rate of hepatotoxicity (24/34, 70.6%) than patients who were anti-HCV negative (43/117, 36.8%) or anti-HCV positive but RNA negative (5/24, 20.8%), as well as a higher incidence of severe hepatotoxicity.

The groups did not differ in the incidence of hair loss, neutropenia, thrombocytopenia, hyperlipidemia, nausea, or anorexia.

"HCV viremia seems to exacerbate adverse reactions, such as rash and hepatotoxicity, to nevirapine-based HAART," the authors conclude. "We suggest nevirapine not be used as part of a HAART regimen when HCV RNA replication exists."

They add, "Increased attention is required to improve the prognosis in the HIV/HCV-coinfected patient."

http://www.ncbi.nlm.nih.gov/pubmed/20431395

J Acquir Immune Defic Syndr 2010.