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A changing paradigm: management and treatment of the HCV/HIV-co-infected patient

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Abstract

Hepatitis C virus (HCV) treatment in HIV/HCV co-infected individuals has renewed relevance given the ongoing opioid crisis and rise of new HIV and HCV infections associated with injection drug use. Patients co-infected with HIV and HCV demonstrate increased rates of hepatic fibrosis, progression to liver failure, and liver-related mortality. HIV co-infection does not impact outcomes of current HCV treatments, and patients should be treated the same as HCV mono-infected persons, though attention to drug:drug interactions is required. In this review, we discuss the mechanisms mediating injury to the liver in HIV mono-infection and HIV/HCV co-infection, and present the landmark trials of HCV treatment in HIV-infected individuals.

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References

  1. Hepatitis C [Internet].; 2017 []. http://www.who.int/news-room/fact-sheets/detail/hepatitis-c. Accessed 12 July 2018.

  2. Abutaleb A, Kottilil S, Wilson E. Glecaprevir/pibrentasvir expands reach while reducing cost and duration of hepatitis C virus therapy. Hepatol Int. 2018;12(3):214–22.

    Article  Google Scholar 

  3. HIV and hepatitis coinfections [Internet]. 2017. http://www.who.int/hiv/topics/hepatitis/en/. Accessed 12 July 2018.

  4. Benhamou Y, Bochet M, Di Martino V, Charlotte F, Azria F, Coutellier A, et al. Liver fibrosis progression in human immunodeficiency virus and hepatitis C virus coinfected patients. The multivirc group. Hepatology. 1999;30(4):1054–8.

    Article  CAS  Google Scholar 

  5. Klein MB, Althoff KN, Jing Y, Lau B, Kitahata M, III Lo Re V, et al. Risk of end-stage liver disease in HIV-viral hepatitis coinfected persons in north america from the early to modern antiretroviral therapy eras. Clin Infect Dis. 2016;63(9):1160–7.

    PubMed  PubMed Central  Google Scholar 

  6. Blackard JT, Hiasa Y, Smeaton L, Jamieson DJ, Rodriguez I, Mayer KH, et al. Compartmentalization of hepatitis C virus (HCV) during HCV/HIV coinfection. J Infect Dis. 2007;195(12):1765–73.

    Article  CAS  Google Scholar 

  7. Blackard JT, Sherman KE. HCV/HIV co-infection: time to re-evaluate the role of HIV in the liver? J Viral Hepat. 2008;15(5):323–30.

    Article  CAS  Google Scholar 

  8. Blackard JT, Welge JA, Taylor LE, Mayer KH, Klein RS, Celentano DD, et al. HIV mono-infection is associated with FIB-4—A noninvasive index of liver fibrosis—in women. Clin Infect Dis. 2011;52(5):674–80.

    Article  Google Scholar 

  9. Han SH, Kim SU, Kim CO, Jeong SJ, Park JY, Choi JY, et al. Abnormal liver stiffness assessed using transient elastography (Fibroscan(R)) in HIV-infected patients without HBV/HCV coinfection receiving combined antiretroviral treatment. PLoS One. 2013;8(1):e52720.

    Article  CAS  Google Scholar 

  10. Hasson H, Merli M, Galli L, Gallotta G, Carbone A, Messina E, et al. Non-invasive fibrosis biomarkers—APRI and forns—are associated with liver stiffness in HIV-monoinfected patients receiving antiretroviral drugs. Liver Int. 2013;33(7):1113–20.

    Article  CAS  Google Scholar 

  11. Brau N, Salvatore M, Rios-Bedoya CF, Fernandez-Carbia A, Paronetto F, Rodriguez-Orengo JF, et al. Slower fibrosis progression in HIV/HCV-coinfected patients with successful HIV suppression using antiretroviral therapy. J Hepatol. 2006;44(1):47–55.

    Article  Google Scholar 

  12. Qurishi N, Kreuzberg C, Luchters G, Effenberger W, Kupfer B, Sauerbruch T, et al. Effect of antiretroviral therapy on liver-related mortality in patients with HIV and hepatitis C virus coinfection. Lancet. 2003;362(9397):1708–13.

    Article  CAS  Google Scholar 

  13. Mastroianni CM, Lichtner M, Mascia C, Zuccala P, Vullo V. Molecular mechanisms of liver fibrosis in HIV/HCV coinfection. Int J Mol Sci. 2014;15(6):9184–208.

    Article  CAS  Google Scholar 

  14. Vlahakis SR, Villasis-Keever A, Gomez TS, Bren GD, Paya CV. Human immunodeficiency virus-induced apoptosis of human hepatocytes via CXCR4. J Infect Dis. 2003;188(10):1455–60.

    Article  CAS  Google Scholar 

  15. Yoong KF, Afford SC, Jones R, Aujla P, Qin S, Price K, et al. Expression and function of CXC and CC chemokines in human malignant liver tumors: a role for human monokine induced by gamma-interferon in lymphocyte recruitment to hepatocellular carcinoma. Hepatology. 1999;30(1):100–11.

    Article  CAS  Google Scholar 

  16. Tuyama AC, Hong F, Saiman Y, Wang C, Ozkok D, Mosoian A, et al. Human immunodeficiency virus (HIV)-1 infects human hepatic stellate cells and promotes collagen I and monocyte chemoattractant protein-1 expression: implications for the pathogenesis of HIV/hepatitis C virus-induced liver fibrosis. Hepatology. 2010;52(2):612–22.

    Article  CAS  Google Scholar 

  17. Munshi N, Balasubramanian A, Koziel M, Ganju RK, Groopman JE. Hepatitis C and human immunodeficiency virus envelope proteins cooperatively induce hepatocytic apoptosis via an innocent bystander mechanism. J Infect Dis. 2003;188(8):1192–204.

    Article  CAS  Google Scholar 

  18. Hong F, Tuyama A, Lee TF, Loke J, Agarwal R, Cheng X, et al. Hepatic stellate cells express functional CXCR4: role in stromal cell-derived factor-1alpha-mediated stellate cell activation. Hepatology. 2009;49(6):2055–67.

    Article  CAS  Google Scholar 

  19. Schwabe RF, Bataller R, Brenner DA. Human hepatic stellate cells express CCR5 and RANTES to induce proliferation and migration. Am J Physiol Gastrointest Liver Physiol. 2003;285(5):G949–58.

    Article  CAS  Google Scholar 

  20. Bruno R, Galastri S, Sacchi P, Cima S, Caligiuri A, DeFranco R, et al. gp120 modulates the biology of human hepatic stellate cells: a link between HIV infection and liver fibrogenesis. Gut. 2010;59(4):513–20.

    Article  CAS  Google Scholar 

  21. Efsen E, Bonacchi A, Pastacaldi S, Valente AJ, Wenzel UO, Tosti-Guerra C, et al. Agonist-specific regulation of monocyte chemoattractant protein-1 expression by cyclooxygenase metabolites in hepatic stellate cells. Hepatology. 2001;33(3):713–21.

    Article  CAS  Google Scholar 

  22. Marra F, DeFranco R, Grappone C, Milani S, Pastacaldi S, Pinzani M, et al. Increased expression of monocyte chemotactic protein-1 during active hepatic fibrogenesis: correlation with monocyte infiltration. Am J Pathol. 1998;152(2):423–30.

    CAS  PubMed  PubMed Central  Google Scholar 

  23. Seki E, De Minicis S, Gwak GY, Kluwe J, Inokuchi S, Bursill CA, et al. CCR1 and CCR5 promote hepatic fibrosis in mice. J Clin Invest. 2009;119(7):1858–70.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Ochoa-Callejero L, Perez-Martinez L, Rubio-Mediavilla S, Oteo JA, Martinez A, Blanco JR. Maraviroc, a CCR5 antagonist, prevents development of hepatocellular carcinoma in a mouse model. PLoS One. 2013;8(1):e53992.

    Article  CAS  Google Scholar 

  25. Affo S, Bataller R. RANTES antagonism: a promising approach to treat chronic liver diseases. J Hepatol. 2011;55(4):936–8.

    Article  Google Scholar 

  26. Berres ML, Koenen RR, Rueland A, Zaldivar MM, Heinrichs D, Sahin H, et al. Antagonism of the chemokine Ccl5 ameliorates experimental liver fibrosis in mice. J Clin Invest. 2010;120(11):4129–40.

    Article  CAS  Google Scholar 

  27. Macias J, Viloria MM, Rivero A, de los Santos I, Marquez M, Portilla J, et al. Lack of short-term increase in serum mediators of fibrogenesis and in non-invasive markers of liver fibrosis in HIV/hepatitis C virus-coinfected patients starting maraviroc-based antiretroviral therapy. Eur J Clin Microbiol Infect Dis. 2012;31(8):2083–8.

    Article  CAS  Google Scholar 

  28. Lin W, Wu G, Li S, Weinberg EM, Kumthip K, Peng LF, et al. HIV and HCV cooperatively promote hepatic fibrogenesis via induction of reactive oxygen species and NFkappaB. J Biol Chem. 2011;286(4):2665–74.

    Article  CAS  Google Scholar 

  29. French AL, Martin JW, Evans CT, Peters M, Kessaye SG, Nowicki M, et al. Macrophage activation and the tumor necrosis factor cascade in hepatitis C disease progression among HIV-infected female participating in the women’s interagency HIV study. J Acquir Immune Defic Syndr. 2017;76(4):438–44.

    Article  CAS  Google Scholar 

  30. Chen JY, Feeney ER, Chung RT. HCV and HIV co-infection: mechanisms and management. Nat Rev Gastroenterol Hepatol. 2014;11(6):362–71.

    Article  CAS  Google Scholar 

  31. Weber R, Sabin CA, Friis-Moller N, Reiss P, El-Sadr WM, Kirk O, et al. Liver-related deaths in persons infected with the human immunodeficiency virus: the D:a: D study. Arch Intern Med. 2006;166(15):1632–41.

    Article  Google Scholar 

  32. Mehal WZ. The Gordian Knot of dysbiosis, obesity and NAFLD. Nat Rev Gastroenterol Hepatol. 2013;10(11):637–44.

    Article  Google Scholar 

  33. Alatrakchi N, Graham CS, van der Vliet HJ, Sherman KE, Exley MA, Koziel MJ. Hepatitis C virus (HCV)-specific CD8 + cells produce transforming growth factor beta that can suppress HCV-specific T-cell responses. J Virol. 2007;81(11):5882–92.

    Article  CAS  Google Scholar 

  34. Gressner AM, Weiskirchen R, Breitkopf K, Dooley S. Roles of TGF-beta in hepatic fibrosis. Front Biosci. 2002;1(7):d793–807.

    Article  Google Scholar 

  35. Reiberger T, Aberle JH, Kundi M, Kohrgruber N, Rieger A, Gangl A, et al. IP-10 correlates with hepatitis C viral load, hepatic inflammation and fibrosis and predicts hepatitis C virus relapse or non-response in HIV-HCV coinfection. Antivir Ther. 2008;13(8):969–76.

    CAS  PubMed  Google Scholar 

  36. Zavadil J, Bottinger EP. TGF-beta and epithelial-to-mesenchymal transitions. Oncogene. 2005;24(37):5764–74.

    Article  CAS  Google Scholar 

  37. Appay V, Sauce D. Immune activation and inflammation in HIV-1 infection: causes and consequences. J Pathol. 2008;214(2):231–41.

    Article  CAS  Google Scholar 

  38. de Oca Arjona MM, Marquez M, Soto MJ, Rodriguez-Ramos C, Terron A, Vergara A, et al. Bacterial translocation in HIV-infected patients with HCV cirrhosis: implication in hemodynamic alterations and mortality. J Acquir Immune Defic Syndr. 2011;56(5):420–7.

    Article  Google Scholar 

  39. Sandler NG, Koh C, Roque A, Eccleston JL, Siegel RB, Demino M, et al. Host response to translocated microbial products predicts outcomes of patients with HBV or HCV infection. Gastroenterology. 2011;141(4):1220–30.

    Article  Google Scholar 

  40. Page EE, Nelson M, Kelleher P. HIV and hepatitis C coinfection: pathogenesis and microbial translocation. Curr Opin HIV AIDS. 2011;6(6):472–7.

    Article  Google Scholar 

  41. Mena A, Meijide H, Rodriguez-Osorio I, Castro A, Poveda E. Liver-related mortality and hospitalizations attributable to chronic hepatitis C virus coinfection in persons living with HIV. HIV Med. 2017;18(9):685–9.

    Article  CAS  Google Scholar 

  42. Behzadpour D, Ahmadi Vasmehjani A, Mousavi Nasab SD, Ahmadi NA, Baharlou R. Impact of HIV infection in patients infected with chronic HCV (genotypes 1a and 3a): virological and clinical changes. Pathog Glob Health. 2016;110(7–8):310–5.

    Article  Google Scholar 

  43. Garrison KL, German P, Mogalian E, Mathias A. The drug-drug interaction potential of antiviral agents for the treatment of chronic hepatitis C infection. Drug Metab Dispos. 2018;46(8):1212–1225.

    Article  CAS  Google Scholar 

  44. Regazzi M, Maserati R, Villani P, Cusato M, Zucchi P, Briganti E, et al. Clinical pharmacokinetics of nelfinavir and its metabolite M8 in human immunodeficiency virus (HIV)-positive and HIV-hepatitis C virus-coinfected subjects. Antimicrob Agents Chemother. 2005;49(2):643–9.

    Article  CAS  Google Scholar 

  45. Szabo G, Mandrekar P, Dolganiuc A. Innate immune response and hepatic inflammation. Semin Liver Dis. 2007;27(4):339–50.

    Article  CAS  Google Scholar 

  46. Matsuzaki K, Murata M, Yoshida K, Sekimoto G, Uemura Y, Sakaida N, et al. Chronic inflammation associated with hepatitis C virus infection perturbs hepatic transforming growth factor beta signaling, promoting cirrhosis and hepatocellular carcinoma. Hepatology. 2007;46(1):48–57.

    Article  CAS  Google Scholar 

  47. Balasubramanian A, Ganju RK, Groopman JE. Signal transducer and activator of transcription factor 1 mediates apoptosis induced by hepatitis C virus and HIV envelope proteins in hepatocytes. J Infect Dis. 2006;194(5):670–81.

    Article  CAS  Google Scholar 

  48. Glassner A, Eisenhardt M, Kokordelis P, Kramer B, Wolter F, Nischalke HD, et al. Impaired CD4(+) T cell stimulation of NK cell anti-fibrotic activity may contribute to accelerated liver fibrosis progression in HIV/HCV patients. J Hepatol. 2013;59(3):427–33.

    Article  CAS  Google Scholar 

  49. Qu J, Zhang Q, Li Y, Liu W, Chen L, Zhu Y, et al. The Tat protein of human immunodeficiency virus-1 enhances hepatitis C virus replication through interferon gamma-inducible protein-10. BMC Immunol. 2012;13:15 (2172-13-15).

    Article  CAS  Google Scholar 

  50. Sherman KE, Guedj J, Shata MT, Blackard JT, Rouster SD, Castro M, et al. Modulation of HCV replication after combination antiretroviral therapy in HCV/HIV co-infected patients. Sci Transl Med. 2014;6(246):246ra98.

    Article  Google Scholar 

  51. Dieterich D, Rockstroh JK, Orkin C, Gutierrez F, Klein MB, Reynes J, et al. Simeprevir (TMC435) with pegylated interferon/ribavirin in patients coinfected with HCV genotype 1 and HIV-1: a phase 3 study. Clin Infect Dis. 2014;59(11):1579–87.

    Article  CAS  Google Scholar 

  52. Sulkowski MS, Naggie S, Lalezari J, Fessel WJ, Mounzer K, Shuhart M, et al. Sofosbuvir and ribavirin for hepatitis C in patients with HIV coinfection. JAMA. 2014;312(4):353–61.

    Article  Google Scholar 

  53. Molina JM, Orkin C, Iser DM, Zamora FX, Nelson M, Stephan C, et al. Sofosbuvir plus ribavirin for treatment of hepatitis C virus in patients co-infected with HIV (PHOTON-2): a multicentre, open-label, non-randomised, phase 3 study. Lancet. 2015;385(9973):1098–106.

    Article  CAS  Google Scholar 

  54. Osinusi A, Townsend K, Kohli A, Nelson A, Seamon C, Meissner EG, et al. Virologic response following combined ledipasvir and sofosbuvir administration in patients with HCV genotype 1 and HIV co-infection. JAMA. 2015;313(12):1232–9.

    Article  CAS  Google Scholar 

  55. Naggie S, Cooper C, Saag M, Workowski K, Ruane P, Towner WJ, et al. Ledipasvir and Sofosbuvir for HCV in Patients Coinfected with HIV-1. N Engl J Med. 2015;373(8):705–13.

    Article  CAS  Google Scholar 

  56. Sulkowski M, Hezode C, Gerstoft J, Vierling JM, Mallolas J, Pol S, et al. Efficacy and safety of 8 versus 12 weeks of treatment with grazoprevir (MK-5172) and elbasvir (MK-8742) with or without ribavirin in patients with hepatitis C virus genotype 1 mono-infection and HIV/hepatitis C virus co-infection (C-WORTHY): a randomised, open-label phase 2 trial. Lancet. 2015;385(9973):1087–97.

    Article  CAS  Google Scholar 

  57. Rockstroh JK, Nelson M, Katlama C, Lalezari J, Mallolas J, Bloch M, et al. Efficacy and safety of grazoprevir (MK-5172) and elbasvir (MK-8742) in patients with hepatitis C virus and HIV co-infection (C-EDGE CO-INFECTION): a non-randomised, open-label trial. Lancet HIV. 2015;2(8):e319–27.

    Article  Google Scholar 

  58. Wyles DL, Ruane PJ, Sulkowski MS, Dieterich D, Luetkemeyer A, Morgan TR, et al. Daclatasvir plus sofosbuvir for HCV in patients coinfected with HIV-1. N Engl J Med. 2015;373(8):714–25.

    Article  CAS  Google Scholar 

  59. Sulkowski MS, Eron JJ, Wyles D, Trinh R, Lalezari J, Wang C, et al. Ombitasvir, paritaprevir co-dosed with ritonavir, dasabuvir, and ribavirin for hepatitis C in patients co-infected with HIV-1: a randomized trial. JAMA. 2015;313(12):1223–31.

    Article  CAS  Google Scholar 

  60. Wyles D, Saag M, Viani RM, Lalezari J, Adeyemi O, Bhatti L, et al. TURQUOISE-I Part 1b: ombitasvir/paritaprevir/ritonavir and dasabuvir with ribavirin for hepatitis C virus infection in HIV-1 coinfected patients on darunavir. J Infect Dis. 2017;215(4):599–605.

    Article  CAS  Google Scholar 

  61. Wyles D, Brau N, Kottilil S, Daar ES, Ruane P, Workowski K, et al. Sofosbuvir and velpatasvir for the treatment of hepatitis C virus in patients coinfected with human immunodeficiency virus type 1: an open-label, phase 3 study. Clin Infect Dis. 2017;65(1):6–12.

    Article  CAS  Google Scholar 

  62. Rockstroh J, Lacombe K, Viani R, Orkin C, Wyles D, Luetkemeyer A, et al. Efficacy and safety of glecaprevir/pibrentasvir in patients co-infected with hepatitis C virus and human immunodeficiency virus-1: the EXPEDITION-2 study. J Hepatol. 2017;66(1):S102–3.

    Article  Google Scholar 

  63. Zeuzem S, Feld JJ, Wang S, Bourlière M, Wedemeyer H, Gane EJ, et al. ENDURANCE-1: efficacy and safety of 8- versus 12-week treatment with ABT-493/ABT-530 in patients with chronic HCV genotype 1 infection. Hepatology. 2016;64(1):132A–3A.

    Google Scholar 

  64. Bruno G, Saracino A, Scudeller L, Fabrizio C, Dell’Acqua R, Milano E, et al. HCV mono-infected and HIV/HCV co-infected individuals treated with direct-acting antivirals: to what extent do they differ? Int J Infect Dis. 2017;62:64–71.

    Article  CAS  Google Scholar 

  65. Rodriguez-Torres M, Gaggar A, Shen G, Kirby B, Svarovskaia E, Brainard D, et al. Sofosbuvir for chronic hepatitis C virus infection genotype 1-4 in patients coinfected with HIV. J Acquir Immune Defic Syndr. 2015;68(5):543–9.

    Article  CAS  Google Scholar 

  66. Tedaldi E, Peters L, Neuhaus J, Puoti M, Rockstroh J, Klein MB, et al. Opportunistic disease and mortality in patients coinfected with hepatitis B or C virus in the strategic management of antiretroviral therapy (SMART) study. Clin Infect Dis. 2008;47(11):1468–75.

    Article  Google Scholar 

  67. Interaction Checker [Internet]. 2018. https://www.hep-druginteractions.org/. Accessed 12 July 2018.

  68. Stock P, Roland M, Carlson L, Freise C, Hirose R, Terrault N, et al. Solid organ transplantation in HIV-positive patients. Transpl Proc. 2001;33(7–8):3646–8.

    Article  CAS  Google Scholar 

  69. Terrault NA, Roland ME, Schiano T, Dove L, Wong MT, Poordad F, et al. Outcomes of liver transplant recipients with hepatitis C and human immunodeficiency virus coinfection. Liver Transpl. 2012;18(6):716–26.

    Article  Google Scholar 

  70. Miro JM, Stock P, Teicher E, Duclos-Vallee JC, Terrault N, Rimola A. Outcome and management of HCV/HIV coinfection pre- and post-liver transplantation. A 2015 update. J Hepatol. 2015;62(3):701–11.

    Article  Google Scholar 

  71. Roland ME, Barin B, Huprikar S, Murphy B, Hanto DW, Blumberg E, et al. Survival in HIV-positive transplant recipients compared with transplant candidates and with HIV-negative controls. AIDS. 2016;30(3):435–44.

    PubMed  PubMed Central  Google Scholar 

  72. Fitzmorris P, Singal AK. Surveillance and diagnosis of hepatocellular carcinoma. Gastroenterol Hepatol (N Y). 2015;11(1):38–46.

    Google Scholar 

  73. Guidelines, version 9.0 [Internet]. 2017. http://www.eacsociety.org/files/guidelines_9.0-english.pdf. Accessed 12 July 2018.

  74. Zeuzem S, Foster GR, Wang S, Asatryan A, Gane E, Feld JJ, et al. Glecaprevir–pibrentasvir for 8 or 12 Weeks in HCV genotype 1 or 3 infection. N Engl J Med. 2018;378(4):354–69.

    Article  CAS  Google Scholar 

  75. Torriani FJ, Rodriguez-Torres M, Rockstroh JK, Lissen E, Gonzalez-Garcia J, Lazzarin A, et al. Peginterferon Alfa-2a plus ribavirin for chronic hepatitis C virus infection in HIV-infected patients. N Engl J Med. 2004;351(5):438–50.

    Article  CAS  Google Scholar 

  76. Zeuzem S, Berg T, Gane E, Ferenci P, Foster GR, Fried MW, et al. Simeprevir increases rate of sustained virologic response among treatment-experienced patients with HCV genotype-1 infection: a phase IIb trial. Gastroenterology. 2014;146(2):430–41.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Clinical Care and Research, Institute of Human Virology, University of Maryland, Baltimore, MD, USA

    Ameer Abutaleb

  2. Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland, Baltimore, MD, USA

    Ameer Abutaleb

  3. Division of Digestive Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, 45267, USA

    Kenneth E. Sherman

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Dr. Sherman has received grants and contracts (paid to institution) from AbbVie, BMS, Gilead, and Merck. He has served on advisory boards for Abbott Laboratories, and Merck on Data Monitoring boards for MedPace and Watermark.

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Abutaleb, A., Sherman, K.E. A changing paradigm: management and treatment of the HCV/HIV-co-infected patient. Hepatol Int 12, 500–509 (2018). https://doi.org/10.1007/s12072-018-9896-4

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