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| HCV:
The Correctional Conundrum
(continued) HIV and HCV Co-Infection
Analyses of the effect of HCV and HIV co-infection on progression of either disease are often confounded by concurrent risk factors for progression. However, available data seems to indicate that HIV infection accelerates HCV liver disease. Persons who are co-infected (HIV / HCV) appear to have a 12 to 300 fold higher risk of developing hepatocellular carcinoma than non-carriers.37 Furthermore, antiretroviral agents can contribute to liver inflammation, and this may be more frequent in those who have underlying chronic hepatitis due to HCV or HBV. Ritonavir appears to be one of the ART medications that is most commonly associated with liver inflammation in HCV/HIV co- infected patients.38 The impact of HCV infection on HIV infection is less clear. In some studies, HCV infection does not appear to have an effect on the progression of HIV.39 Other studies have reported an association between more rapid progression to AIDS or death in HIV-infected patients; particularly among those who were co-infected with HCV genotypes 1a and 1b.40, 41 However, a report by Sulkowski at CROI contraindicated these findings, suggesting that risk of progression was more linked to lack of access to medical care (for HIV) in his cohort of African American patients who had HIV and HCV co-infection (CROI abstract 34). Response to HCV therapy in individuals who also have HIV infection appears to be equivalent to that of non-HIV infected individuals.42 A recent study in the Journal of the American Medical Association by Sulkowski et al indicates that 88% of co-infected patients tolerate concurrent HCV treatment and HAART.43 Following successful HCV treatment, co-infected patients are not more likely to relapse after HCV treatment than are patients who do not have concurrent HIV infection. Currently, when exclusionary criteria are not present (see Table 2), 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 200 with a stable viral load less than 400 is generally accepted.44 |
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