Traditional therapies for hepatitis C are not as effective in people who have HIV

People With HIV Have Less Successful Hepatitis C Treatment And Poorer Outcomes Than People Without HIV

No Comment By Meerat Oza and Courtney McQueen Published: Feb 4, 2011 5:07 pm

A recent review of coinfection with HIV and hepatitis C has found that HIV causes hepatitis C to progress more quickly and that traditional therapies for hepatitis C are not as effective in people who have HIV. The review also noted that the prognosis was better for people who were taking antiretroviral therapy to treat their HIV than for people who were not.

The authors recommended that people who test positive for HIV also be tested for the hepatitis C virus (HCV) and that all patients with HIV-HCV coinfection be considered for HCV antiviral treatment.

Hepatitis C is a liver disease caused by HCV. If untreated, infection with HCV can cause damage and scarring to the liver, liver cancer, and eventually liver failure. Once the liver fails, a liver transplant is necessary for a patient to survive. Some people who are infected can spontaneously clear the virus themselves; the rest need treatment with antiviral drugs. The cure rate of current HCV antivirals is about 50 percent.

Since HCV and HIV are transmitted in the same ways, coinfection with both HIV and HCV is very common. Around a quarter to a third of people with HIV are thought to also have HCV, with 50 percent to 90 percent of HIV-positive injection drug users having HCV.

With the advent of highly active antiretroviral therapy (HAART), overall deaths due to AIDS-related complications have decreased in people with HIV; at the same time, however, deaths due to liver disease caused by HCV have increased. Currently, only about a third of patients who are HIV-HCV coinfected receive treatment for HCV.

In this review, the authors summarized current research with regard to the effects of HIV-HCV coinfection and the current efficacy of HCV treatments in people with HIV.

The review authors found that, while there is little evidence that HCV affects the progression of HIV, HIV does appear to affect the progression of hepatitis C. People with HIV are less likely to spontaneously eliminate HCV; only 5 percent of HIV-positive patients did so, versus 14 percent to 45 percent of HIV-negative patients with HCV.

In addition, people with HIV experienced greater and faster liver scarring than people with HCV who did not have HIV.

The review authors also found that HCV treatment is less effective in people with HIV. Older treatments for HCV usually included interferon (Intron, Roferon) plus ribavirin (Copegus). Newer treatment regimens usually consist of Pegasys (pegylated interferon alfa-2a) plus ribavirin. Pegasys is a more active form of interferon.

According to four studies conducted in 2004, Pegasys and ribavirin were more effective in treating HCV in HIV-positive patients than the combination of interferon and ribavirin. However, fewer people who had HIV achieved a sustained viral response for HCV, partly because of high treatment discontinuation rates (up to 39 percent) due to side effects.
A sustained viral response means that HCV levels are undetectable 24 weeks after completion of antiviral therapy. In 99 percent of patients, achieving a sustained viral response indicates that HCV has been permanently eliminated from the body.

The authors of the review also noted that certain anti-HIV medications can interact poorly with HCV antivirals. Specifically, didanosine (Videx) can lead to potentially fatal side effects when taken with ribavirin, so the two drugs should not be taken together. Zidovudine (retrovir) can also worsen ribavirin side effects and Ziagen (abacavir) can make it less effective, so they also should be avoided during HCV treatment with ribavirin.

However, studies have shown that patients receiving HAART have better liver-related outcomes than those who are not receiving HAART. In a study of 153 HIV-HCV coinfected patients, the probability of survival after one year was 60 percent for patients receiving HAART compared to 38 percent for patients not receiving HAART.

The review authors noted that studies have found that around 70 percent of HIV-HCV coinfected patients were considered ineligible for HCV antiviral treatment by their physicians due to factors such as failure to keep appointments, drug and alcohol abuse, or mental illness.
However, because of the damage caused by HCV, the authors urged that physicians ensure HCV treatment is available to all eligible patients. They noted that the assistance of substance abuse counselors or mental health professionals may be beneficial.
For more information, please see the review in Clinics in Liver Disease
(abstract).
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