HCV
in Corrections: Frontline or Backwater?
(continued)
HIV/HCV Response to therapy
HCV-infected and HIV/HCV
coinfected patients respond to standard interferon plus ribavirin HCV therapy34
provided that the HIV infection of the coinfected patient is under control,
meaning that the patient's CD4 count is above 300 at the start of HCV treatment.35
Studies of coinfected patients on the new treatment standard, pegylated
interferon plus ribavirin, have shown that after 12 weeks, 35% of coinfected
patients are HCV RNA negative and 43% had achieved a minimum of a 2-log
reduction in HCV viral load.36 A study by Turriani and colleagues has found
that HIV co-infection does contribute to a slower clearance rate of HCV.37
However, the discontinuation rate of co-infected patients has matched discontinuation
rates of HCV monoinfected patients (about 14 %),38 indicating that HAART
and HCV therapy can be concomitantly administered. Patients who start HAART
early in HIV have a better clinical prognosis and decreased liver fibrosis
than patients who wait to begin HIV treatment.40
Currently, when exclusionary
criteria are not present, treatment of hepatitis C is recommended for patients
when CD4 and viral load values reflect good response to antiretroviral
treatment. Although some controversy remains in regard to the definition
of a good response to HAART, a stable CD4 T cell count greater than 300
with a stable viral load less than 400 is generally accepted.35, 41 Coinfected
patients should also be treated with pegylated interferon plus ribavirin,
as this new standard of care results in better outcomes for coinfected
as well as HCV monoinfected patients. In a new study this treatment was
well tolerated in coinfected patients, and there were no adverse affects
on the HIV disease when using pegylated interferon in combination with
ribavirin.35
CONTINUE...
|
|
|
