Brad Hare, MD, associate professor of clinical medicine at UCSF and medical director of the Positive Health Program at San Francisco General Hospital and Trauma Center, reports here on a panel at the XIX International AIDS Conference that included UCSF’s Annie Luetkemeyer about a new era in hepatitis C treatment, which is an increasing cause for concern. See related videos here on the importance of diagnosing hepatitis C early in the course of infection and here and here on new hepatitis C therapies. Also see Hare’s earlier report on some of the latest hepatitis C research at the conference. Here is Hare’s latest report:
Over the last few years, cases of acute hepatitis C virus (HCV) infection, often acquired through sexual transmission among men who have sex with men (MSM), have been increasingly recognized.
Dr. Daniel Fierer reviewed data suggesting more rapid progression of liver fibrosis/scarring after acute HCV infection in HIV-infected individuals, including four cases of rapid progression to liver decompensation within 2-7 years after new HCV infection. He suggested that acquiring HCV on top of pre-existing HIV, particularly at lower CD4 counts, may be partially responsible for this rapid progression.
Dr. Lo Re reported increased rates of liver decompensation (6.3% vs. 5.0%) among HIV/HCV co-infected patients who were on antiretroviral therapy compared to HCV mono-infected patients in the Veterans Aging Cohort.
Treatment for HCV infection is currently undergoing dramatic changes – becoming more effective with shorter treatment duration and including the possibility of all-oral regimens in the near future.
Translating strategies using new drugs and novel treatments to HIV co-infected patients, who have lower treatment responses to standard interferon-ribavirin treatment regimens, is urgently needed.
Dr. Annie Luetkemeyer from the UCSF HIV/AIDS Division presented findings from ACTG 5269 in which nitazoxanide (NTZ) was added to standard HCV treatment with pegylated interferon and ribavirin. While NTZ did not significantly improve HCV virologic cure rates overall, there was a signal for improved responses with the addition of NTZ among patients who had IL28B T/T genotype, which is typically associated with poorer responses to interferon-based therapy.
These observations taken together should remind patients and clinicians to be aware of the possibility of acute HCV infection in HIV-infected patients, particularly MSM, and to screen, diagnose and treat patients with the best regimens possible to cure HCV and prevent liver fibrosis.
Brad Hare Photo by Susan Merrell/UCSF