HIV positive people with liver disease such as hep B or C are more likely
to develop liver-related side effects while taking HIV therapy than those
who don’t have hepatitis.
However, the protease inhibitor (PI) atazanavir (Reyataz) is less likely to
mess up your liver function than some other drugs in this class.
This drug is likely to cause elevated bilirubin levels, which may cause jaundice,
yellowing of the skin and whites of the eyes.
These conclusions were based on results from four clinical trials of atazanavir
or atazanavir with a boosting dose of the PI ritonavir (including 866 people
living with HIV). Around a quarter took atazanavir/ritonavir while the rest
took atazanavir alone. In total 134 (15 per cent) participants in the studies
were co-infected with hep B or C.
People with hepatitis co-infection were no more likely to discontinue treatment,
nor did they experience more frequent bouts of jaundice.
Rates of treatment discontinuation due to side effects were similar in the
co-infected and mono-infected groups. However, co-infected people were more
likely to experience mild to moderate liver function elevations compared with
people living with HIV only.
The authors concluded that atazanavir and atazanavir/ ritonavir were safe
treatments for people also infected with hepatitis C or B.
l XVI IAC, Toronto, 2006. Abstract WEPE0054/10066
Higher HCV viral load linked
to low CD4 count
People co-infected with HIV and hepatitis C with a well preserved immune system
and high CD4 counts appear to experience slower liver disease progression
than those with lower CD4 counts.
Analysing data from 1,023 HIV-HCV co-infected people in the Swiss HIV cohort,
researchers found people with current CD4 counts below 200 cells had significantly
higher hep C virus levels. Lowest ever CD4 count was also linked to higher
HCV viral load.
People with CD4 counts lower than 200 and detectable HIV viral load above
400 had highest hep C virus levels.
Lowest hep C virus level were found in those with CD4 counts above 500 and
undetectable HIV viral load.
A person’s gender, ethnicity, mode of HIV transmission, liver enzyme
levels and hep B co-infection status did not significantly influence their
hep C viral load.
“HCV levels were significantly higher in individuals with low CD4 counts
and detectable HIV, and differed markedly between HCV genotypes,” the
researchers said.
“But the absolute differences in HCV titres [levels] were small and
the clinical relevance of these findings warrants further studies,”
they cautioned.
l Abstract 925, 14th CROI, 2007
Hep C treatment in co-infected
proves life-prolonging and cost-effective
Hepatitis C treatment is cost effective in people co-infected with HIV and
provides “substantial” benefits in life expectancy, according
to new research.
Harvard researchers analysed data from recent clinical trials to estimate
the potential health benefits, cost, and cost effectiveness of three hep C
treatment strategies in people with stable HIV.
Almost all those included in the analysis had CD4 counts above 200, the average
age was 44 and two-thirds had hep C genotype 1.
Pegylated interferon-alfa and ribavirin was consistently more effective and
cost-effective than interferon-alfa and ribavirin, or pegylated interferon-alfa
alone, particularly in patients who didn’t have genotype 1 (genotypes
2, 3, 4 etc).
People who didn’t have genotype 1, who usually respond better to treatment,
experienced greater life expectancy gains at a lower cost. Results were very
similar for women and men.
“For co-infected patients with stable HIV disease, treatment appears
to be not only life-prolonging but cost-effective as well,” the researchers
concluded.
l Am J Med 2007;120:272-279
Co-infected mums-to-be more likely to pass
on hep C to infants
Women living with HIV and hep C are twice as likely to transmit hepatitis
C to their unborn baby, compared with HIV negative women.
Co-infected women with detectable hep C virus levels are three times as likely
to transmit hep C to their baby. Between four and ten per cent of women with
hep C will transmit the virus to their baby; HIV co-infection increases this
risk.
Researchers assessed results from a large number of published studies and
drew the same conclusion as a 2003 look back exercise that found co-infected
women were more likely to infect their babies.
But these researchers warned that larger controlled studies were needed with
clear selection criteria and using standardised hep C testing.
l Clin Inf Dis 44:1123-1131, 2007
l Int J Epidemiol 32:727-734, 2003
