Triple therapy for hepatitis C in people with HIV co-infection

There are hopeful signs that triple therapy for hepatitis C virus (HCV) can achieve good outcomes in people with HIV co-infection.

Doctors in France looked at end-of-treatment responses among people with HIV and HCV co-infection who started triple-drug HCV treatment, often during routine care. Nearly three-quarters had an undetectable hepatitis C viral load after completing therapy.

The study adds considerably to our understanding of the safety and effectiveness of new anti-HCV drugs, as most of the existing data come from clinical trials, which usually have strict exclusion criteria, limiting the range of people in whom new drugs are tested.

Large numbers of people with HIV also have hepatitis C co-infection. Liver disease caused by this co-infection is now an important cause of serious illness and death.

HCV can be treated and cured. Until recently, therapy consisted of dual therapy with pegylated interferon and ribavirin. On the whole, people with co-infection do not do well on this combination.

However, two anti-HCV protease inhibitors have recently been approved – boceprevir (Victrelis) and telaprevir (Incivo or Incivek). Results from clinical trials show that adding these drugs to dual therapy can lead to improved treatment outcomes in people with co-infection. However, they have complex dosing schedules, can cause side-effects and have significant interactions with anti-HIV drugs.

French doctors wanted to examine outcomes in people treated with triple therapy in 'real-world' settings.

Their study sample consisted of 320 people, all of whom had the difficult-to-treat HCV genotype-1 infection. Among those who started triple therapy, 80 patients (70%) did so outside a clinical trial.

Many of the study participants had characteristics associated with poor treatment outcomes. Approximately a third had liver cirrhosis and 71% had taken a previous, unsuccessful course of dual HCV treatment.

A quarter of individuals had mental health problems – a possible contraindication for HCV treatment.

The majority of participants (71% overall, 84% outside trials) took treatment based on telaprevir, with 21% treated with boceprevir-based therapy. The remaining participants took another experimental drug.

At the end of treatment, 74% of people taking telaprevir-containing therapy had an undetectable HCV viral load, as did 60% of people taking boceprevir.

Treatment outcomes were best in people taking HCV therapy for the first time and in those with less advanced liver disease.

The researchers think these results are promising and are eagerly awaiting data showing how many people still had an undetectable HCV viral load 24 weeks after the completion of treatment – a sustained virologic response (SVR), considered a cure. 

Interested in hepatitis and HIV? Visit our hepatitis C topics page for more resources, feature articles and news about hepatitis and HIV co-infection. We’re also working with ELPA, the European Liver Patients Association, on a hepatitis information website for patient advocates and professionals working in hepatitis in Europe – check it out at www.infohep.org

HIV and pregnancy

Women living with HIV often feel that they are “under surveillance” during pregnancy and the early stages of motherhood, according to new Canadian research.

With the right treatment and care, the risk of HIV being passed on from a mother with HIV to her baby during pregnancy, birth or breastfeeding can be reduced to below 1%.

Researchers in Canada wanted to find out more about HIV-positive women’s experiences of pregnancy and motherhood.

They interviewed 33 women in the final stages of pregnancy and three months after giving birth.

It was apparent that some women felt that they were under the scrutiny not only of medical professionals but also family and friends. As well as receiving lots of advice, suggestions and queries about how they were managing their pregnancy, well-meaning relatives and acquaintances often took a particular interest in whether the women were breastfeeding or not. These questions felt intrusive, and women feared that their HIV status could be revealed.

A quarter of women also found themselves in contact with child protection services – who were concerned about the risk of HIV transmission – and often faced very critical questioning.

The researchers believe surveillance results in mothers having their authority challenged, undermined or taken away. They therefore called for moving away from a state of “social surveillance, monitoring, interrogation and criminalisation of HIV-positive mothers” to a situation in which mothering with HIV is normalised, accepted, and left alone. 

Are you a woman living with HIV in the UK and pregnant, or thinking about having a baby? Or are you planning a pregnancy with a man who has HIV? Our online tool HIV & pregnancy is designed to provide you with key information: www.aidsmap.com/pregnancy