Start HAART rather than HCV therapy first, suggests Canadian research

HAART is not only successful at lowering HIV viral load in individuals coinfected with HIV and hepatitis C virus (HCV), but slows the rate of liver fibrosis, according to a Canadian poster presentation to the 43^rd Interscience Conference on Antimicrobial Agents and Chemotherapy in Chicago, which is taking place between September 14 - 17^th.

Anti-HCV therapy shows poor efficacy in coinfected patients, with only 10% - 20% achieving a sustained virological response after the completion of anti-HCV therapy.

As there is still debate about whether HIV or HCV should be treated first in coinfected patients, investigators collected data on the 236 HIV-HCV coinfected patients treated at the Ottawa Hospital. Fibrosis rates and the success of anti-HIV and anti-HCV therapies were calculated after a liver biopsy was performed on a sample of 16 patients.

Patients had an average age of 43 years, and were overwhelmingly male. The median duration of HCV infection at the time of biopsy was calculated to be 18.1 years. The mean ALT value was 128u/L, and mean fibrosis stage was 2.38 (on a scale of zero to four). Fibrosis was calculated to be progressing at a rate of 0.165 per year of HCV infection.

The hospital’s HCV monoinfected patients were also biopsied to provide comparison data, and although they had, on average, been infected with HCV for longer (mean 25 years), they had better liver function (mean ALT 100u/L), less fibrosis ( mean stage 1.64) and were experiencing slower disease progression (mean fibrosis rate per year infected 0.097).

As expected, in both the co-infected and monoinfected patients, alcohol consumption of more than 50mg a day and being male increased the rate of fibrosis. These risk factors have been demonstrated in several earlier studies.

In the co-infected patients, the fibrosis rate was slower than in the ten HAART-treated patients (0.132) than in the six patients who did not receive anti-HIV therapy.

Amongst the 108 HIV-HCV coinfected individuals who started HAART before commencing anti-HCV therapy, 65 (60%) remained on anti-HIV treatments for at least six months and achieved an HIV viral load below 500 copies/mL.

Anti-HCV therapy consisting of interferon-alpha and ribavirin was provided to eleven coinfected individuals. The response to therapy was poor, with only three patients (27%) remaining on treatment for six months, and of these only one patient (10%) had a sustained virologic response (HCV PCR negative six months after completing anti-HCV therapy). This compared unfavourably with the treatment response seen in the 43 HCV monoinfected patients included in analysis, of whom 22 (61%) had a achieved a virologic response at month six, with 17 remaining on treatment for six months and 13 achieving a sustained virologic response.

The investigators conclude that as anti-HCV therapy achieves poor results in HIV-positive individuals coinfected with HCV, efforts should be focused on starting and maintaining HAART (which their results suggest is not only effective against HIV, but slows the rate of liver fibrosis).