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Challenges in the HIV patient coinfected with hepatitis C

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Abstract

Hepatitis C infection (HCV) in HIV-infected individuals is prevalent. HCV-mediated hepatic disease is clearly exacerbated in the setting of HIV disease and is of increasing concern as coinfected patients live longer on highly active antiretroviral therapy (HAART). Treatment for HCV in the setting of HIV coinfection is rapidly evolving. Complex treatment issues arise in patients requiring the multiple antiviral therapies that target HCV and HIV. This review focuses on the major issues involved in the pathogenesis and treatment of coinfected patients in the era of HAART.

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References and Recommended Reading

  1. Alter MJ: Hepatitis C virus infection in the United States. J Hepatol 1999, 31(suppl 1):88–91. Comprehensive review of the epidemiology of HCV infection in the United States.

    Article  PubMed  Google Scholar 

  2. Dieterich DT: Hepatitis C virus and human immunodeficiency virus: clinical issues in coinfection. Am J Med 1999, 107:79S-84S.

    Article  PubMed  CAS  Google Scholar 

  3. Sherman KE, Rouster SD, Chung RT, et al.: Hepatitis C Virus prevalence among patients infected with human immunodeficiency virus: a cross-sectional analysis of the US adult AIDS Clinical Trials Group. Clin Infect Dis 2002, 34:831–837.

    Article  PubMed  Google Scholar 

  4. Lauer GM, Walker BD: Hepatitis C virus infection. N Engl J Med 2001, 345:41–52.

    Article  PubMed  CAS  Google Scholar 

  5. Piroth L, Grappin M, Cuzin L, et al.: Hepatitis C virus coinfection is a negative prognostic factor for clinical evolution in human immunodeficiency virus-positive patients. J Viral Hepatol 2000, 7:302–308.

    Article  CAS  Google Scholar 

  6. Greub G, Ledergerber B, Battegay M, et al.: Clinical progression, survival, and immune recovery during antiretroviral therapy in patients with HIV-1 and hepatitis C virus coinfection: the Swiss HIV Cohort Study. Lancet 2000, 356:1800–1805. This large trial demonstrated the negative impact of HCV infection on clinical progression of HIV disease. The study noted impaired CD4 count recovery in coinfected patients on HAART.

    Article  PubMed  CAS  Google Scholar 

  7. Allory Y, Charlotte F, Benhamou Y, et al.: Impact of human immunodeficiency virus infection on the histological features of chronic hepatitis C: a case-control study. The MULTIVIRC group. Hum Pathol 2000, 31:69–74. This study examined liver biopsies from matched groups of patients with HCV infection alone or with HIV coinfection. Biopsy scoring demonstrated more significant liver disease in coinfected patients. Coinfected patients were more likely to have cirrhotic livers if CD4 counts were less than 200. Patients were matched for alcohol consumption, age, and duration of HCV infection.

    Article  PubMed  CAS  Google Scholar 

  8. Telfer P, Sabin C, Devereux H, et al.: The progression of HCV-associated liver disease in a cohort of haemophilic patients. Br J Haematol 1994, 87:555–561.

    Article  PubMed  CAS  Google Scholar 

  9. Garcia-Samaniego J, Rodriguez M, Berenguer J, et al.: Hepatocellular carcinoma in HIV-infected patients with chronic hepatitis C. Am J Gastroenterol 2001, 96:179–183.

    PubMed  CAS  Google Scholar 

  10. Sulkowski MS, Mast EE, Seeff LB, et al.: Hepatitis C virus infection as an opportunistic disease in persons infected with human immunodeficiency virus. Clin Infect Dis 2000, 30(suppl 1):S77-S84.

    Article  PubMed  Google Scholar 

  11. Cribier B, Schmitt C, Rey D, et al.: HIV increases hepatitis C viraemia irrespective of the hepatitis C virus genotype. Res Virol 1997, 148:267–271.

    Article  PubMed  CAS  Google Scholar 

  12. Roque-Afonso AM, Robain M, Simoneau D, et al.: Influence of CD4 cell counts on the genetic heterogeneity of hepatitis C virus in patients coinfected with human immunodeficiency virus. J Infect Dis 2002, 185:728–733.

    Article  PubMed  Google Scholar 

  13. Soriano V, Martin-Carbonero L, Garcia-Samaniego J, et al.: Mortality due to chronic viral liver disease among patients infected with human immunodeficiency virus. Clin Infect Dis 2001, 33:1793–1795.

    Article  PubMed  CAS  Google Scholar 

  14. Bica I, McGovern B, Dhar R, et al.: Increasing mortality due to end-stage liver disease in patients with human immunodeficiency virus infection. Clin Infect Dis 2001, 32:492–497. This study highlighted the dramatic increase in morbidity and mortality due to hepatic disease that has been observed in coinfected patients in the HAART era.

    Article  PubMed  CAS  Google Scholar 

  15. Moorman JP, Joo M, Hahn YS: Evasion of host immune surveillance by hepatitis C virus: potential roles in viral persistence. Arch Immunol Ther Exp (Warsz) 2001, 49:189–194.

    CAS  Google Scholar 

  16. Cerny A, Chisari FV: Pathogenesis of chronic hepatitis C: immunological features of hepatic injury and viral persistence. Hepatology 1999, 30:595–601.

    Article  PubMed  CAS  Google Scholar 

  17. Tsai SL, Liaw YF, Chen MH, et al.: Detection of type 2-like T-helper cells in hepatitis C virus infection: implications for hepatitis C virus chronicity. Hepatology 1997, 25:449–458.

    Article  PubMed  CAS  Google Scholar 

  18. Alatrakchi N, Di Martino V, Thibault V, et al.: Strong CD4 Th1 responses to HIV and hepatitis C virus in HIV-infected long-term non-progressors co-infected with hepatitis C virus. AIDS 2002, 16:713–717.

    Article  PubMed  Google Scholar 

  19. Lauer GM, Nguyen TN, Day CL, et al.: Human immunodeficiency virus type 1-hepatitis C virus coinfection: intraindividual comparison of cellular immune responses against two persistent viruses. J Virol 2002, 76:2817–2826.

    Article  PubMed  CAS  Google Scholar 

  20. Tsai SL, Chen YM, Chen MH, et al.: Hepatitis C virus variants circumventing cytotoxic T lymphocyte activity as a mechanism of chronicity. Gastroenterology 1998, 115:954–965.

    Article  PubMed  CAS  Google Scholar 

  21. Legrand E, Neau D, Galperine T, et al.: CD4 T Lymphocyte proliferative responses to hepatitis C virus (HCV) antigens in patients coinfected with HCV and human immunodeficiency virus who responded to anti-HCV treatment. J Infect Dis 2002, 186:302–311.

    Article  PubMed  CAS  Google Scholar 

  22. Poynard T, Marcellin P, Lee SS, et al.: Randomised trial of interferon alpha2b plus ribavirin for 48 weeks or for 24 weeks versus interferon alpha2b plus placebo for 48 weeks for treatment of chronic infection with hepatitis C virus. International Hepatitis Interventional Therapy Group (IHIT). Lancet 1998, 352:1426–1432.

    Article  PubMed  CAS  Google Scholar 

  23. Cribier B, Rey D, Schmitt C, et al.: High hepatitis C viraemia and impaired antibody response in patients coinfected with HIV. AIDS 1995, 9:1131–1136.

    Article  PubMed  CAS  Google Scholar 

  24. Serfaty L, Costagliola D, Wendum D, et al.: Impact of early-untreated HIV infection on chronic hepatitis C in intravenous drug users: a case-control study. AIDS 2001, 15:2011–2016.

    Article  PubMed  CAS  Google Scholar 

  25. Yee TT, Griffioen A, Sabin CA, et al.: The natural history of HCV in a cohort of haemophilic patients infected between 1961 and 1985. Gut 2000, 47:845–851.

    Article  PubMed  CAS  Google Scholar 

  26. Goedert JJ, Hatzakis A, Sherman KE, et al.: Lack of association of hepatitis C virus load and genotype with risk of end-stage liver disease in patients with human immunodeficiency virus coinfection. J Infect Dis 2001, 184:1202–1205.

    Article  PubMed  CAS  Google Scholar 

  27. Eyster ME, Sherman KE, Goedert JJ, et al.: Prevalence and changes in hepatitis C virus genotypes among multitransfused persons with hemophilia. The Multicenter Hemophilia Cohort Study. J Infect Dis 1999, 179:1062–1069.

    Article  PubMed  CAS  Google Scholar 

  28. Nunez M, Rios P, Martin-Carbonero L, et al.: Role of hepatitis C virus genotype in the development of severe transaminase elevation after the introduction of antiretroviral therapy. J Acquir Immune Defic Syndr Hum Retrovirol 2002, 30:65–68.

    Google Scholar 

  29. Wong JB, Bennett WG, Koff RS, et al.: Pretreatment evaluation of chronic hepatitis C: risks, benefits, and costs. JAMA 1998, 280:2088–2093.

    Article  PubMed  CAS  Google Scholar 

  30. Mauss S, Klinker H, Ulmer A, et al.: Response to treatment of chronic hepatitis C with interferon alpha in patients infected with HIV-1 is associated with higher CD4+ cell count. Infection 1998, 26:16–19.

    Article  PubMed  CAS  Google Scholar 

  31. Soriano V, Sulkowski M, Bergin C, et al.: Care of patients with chronic hepatitis C and HIV co-infection: recommendations from the HIV-HCV International Panel. AIDS 2002, 16:813–828. These recommendations represent the first comprehensive set of guidelines generated for treatment of the coinfected population. A consensus of opinions was generated from an international panel of experts in the area of HIV and HCV coinfection.

    Article  PubMed  Google Scholar 

  32. McHutchison JG, Gordon SC, Schiff ER, et al.: Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. Hepatitis Interventional Therapy Group. N Engl J Med 1998, 339:1485–1492.

    Article  PubMed  CAS  Google Scholar 

  33. Landau A, Batisse D, Piketty C, et al.: Long-term efficacy of combination therapy with interferon-alpha 2b and ribavirin for severe chronic hepatitis C in HIV-infected patients. AIDS 2001, 15:2149–2155.

    Article  PubMed  CAS  Google Scholar 

  34. Sauleda S, Juarez A, Esteban JI, et al.: Interferon and ribavirin combination therapy for chronic hepatitis C in human immunodeficiency virus-infected patients with congenital coagulation disorders. Hepatology 2001, 34:1035–1040.

    Article  PubMed  CAS  Google Scholar 

  35. Manns MP, McHutchison JG, Gordon SC, et al.: Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for initial treatment of chronic hepatitis C: a randomised trial. Lancet 2001, 358:958–965.

    Article  PubMed  CAS  Google Scholar 

  36. Poynard T, McHutchison J, Manns M, et al.: Impact of pegylated interferon alfa-2b and ribavirin on liver fibrosis in patients with chronic hepatitis C. Gastroenterology 2002, 122:1303–1313.

    Article  PubMed  CAS  Google Scholar 

  37. Chung RT: Pegylated interferon alfa-2a with ribavirin vs. interferon alfa-2a with ribavirin for the treatment of chronic HCV Coinfection. Paper presented at the 9th Annual Conference on Retroviruses and Opportunistic Infections. Seattle, Washington: February 24–28th, 2002, Abstract LB15. This abstract outlines preliminary data from one of the largest prospective, randomized, controlled studies using pegylated IFN and ribavirin for the treatment of coinfected patients.

  38. Sherman KE: HCV RNA kinetic response to PEG-interferon and rivavirin in HIV coinfected patients. Paper presented at the 9th Annual Conference on Retroviruses and Opportunistic Infections. Seattle, Washington: February 24–28th, 2002, Abstract 122.

  39. Dusheiko G: Side effects of alpha interferon in chronic hepatitis C. Hepatology 1997, 26:112S-121S.

    Article  PubMed  CAS  Google Scholar 

  40. Pesce A, Taillan B, Rosenthal E, et al.: Opportunistic infections and CD4 lymphocytopenia with interferon treatment in HIV-1 infected patients. Lancet 1993, 341:1597.

    Article  PubMed  CAS  Google Scholar 

  41. Dieterich DT: Treatment of hepatitis C and anemia in human immunodeficiency virus-infected patients. J Infect Dis 2002, 185(suppl 2):S128-S137.

    Article  PubMed  CAS  Google Scholar 

  42. Landau A, Batisse D, Piketty C, et al.: Lack of interference between ribavirin and nucleosidic analogues in HIV/HCV co-infected individuals undergoing concomitant antiretroviral and anti-HCV combination therapy. AIDS 2000, 14:1857–1858.

    Article  PubMed  CAS  Google Scholar 

  43. Lafeuillade A, Hittinger G, Chadapaud S: Increased mitochondrial toxicity with ribavirin in HIV/HCV coinfection. Lancet 2001, 357:280–281.

    Article  PubMed  CAS  Google Scholar 

  44. Sulkowski MS, Thomas DL, Chaisson RE, et al.: Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis C or B virus infection. JAMA 2000, 283:74–80. One of several studies that addressed the issue of hepatotoxicity in the coinfected population. This prospective cohort study examined the role of PIs and nucleoside analogues in inducing hepatotoxicity and found a significant role for ritonavir in this process. NNRTIs were not examined in this study.

    Article  PubMed  CAS  Google Scholar 

  45. Nunez M, Lana R, Mendoza JL, et al.: Risk factors for severe hepatic injury after introduction of highly active antiretroviral therapy. J Acquir Immune Defic Syndr Hum Retrovirol 2001, 27:426–431.

    CAS  Google Scholar 

  46. Boubaker K, Flepp M, Sudre P, et al.: Hyperlactatemia and antiretroviral therapy: the Swiss HIV Cohort Study. Clin Infect Dis 2001, 33:1931–1937.

    Article  PubMed  CAS  Google Scholar 

  47. Ragni MV, Bontempo FA: Increase in hepatitis C virus load in hemophiliacs during treatment with highly active antiretroviral therapy. J Infect Dis 1999, 180:2027–2029.

    Article  PubMed  CAS  Google Scholar 

  48. John M, Flexman J, French MA: Hepatitis C virus-associated hepatitis following treatment of HIV-infected patients with HIV protease inhibitors: an immune restoration disease? AIDS 1998, 12:2289–2293.

    Article  PubMed  CAS  Google Scholar 

  49. Zylberberg H, Pialoux G, Carnot F, et al.: Rapidly evolving hepatitis C virus-related cirrhosis in a human immunodeficiency virus-infected patient receiving triple antiretroviral therapy. Clin Infect Dis 1998, 27:1255–1258.

    Article  PubMed  CAS  Google Scholar 

  50. Trimoulet P, Neau D, Le Bail B, et al.: Intrahepatic HCV RNA loads in 37 HIV-HCV co-infected patients with controlled HIV infection. J Med Virol 2002, 67:143–151.

    Article  PubMed  CAS  Google Scholar 

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Moorman, J. Challenges in the HIV patient coinfected with hepatitis C. Current Hepatitis Reports 1, 9–15 (2002). https://doi.org/10.1007/s11901-002-0003-9

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