Liver
disease progression (fibrosis) tends to be more rapid in people co-infected
with hepatitis C and HIV. But this appears less so in co-infected people with
well controlled HIV and high CD4 counts.
In people with hep C alone, interferon therapy slows liver fibrosis progression.
But researchers wanted to find out if this was also the case in people co-infected
with HIV and hep C.
Researchers used liver biopsies in 74 co-infected people to compare fibrosis
progression rates and the estimated time to liver cirrhosis.
Participants were divided up by type of treatment: conventional interferon,
pegylated interferon plus ribavirin, or no therapy.
Patients treated with pegylated interferon (Pegasys) experienced a decrease
in fibrosis progression rate and stabilisation of the time to cirrhosis.
The untreated group had twice the fibrosis progression rate and a time-to-cirrhosis
of just over nine years compared with 22.7 years for treated patients.
Hep C therapy improved grading (how fast the disease is changing), but only
those on pegylated interferon had a ‘staging’ decrease which indicates
a slowing of disease progression.
In people treated with Pegasys plus ribavirin, sustained responders and non-responders
had similar liver fibrosis progression rates and staging.
The authors concluded: “In patients with HIV-HCV co-infection [pegylated
interferon alfa-2a] based treatment produced regression or stable fibrosis
in contrast to accelerated progression in those without treatment."
• Journal of Hepatology 46(4): 613-619. April 2007.
Vast majority remain ‘cured’
after successful therapy
The current standard of care for treating chronic hepatitis C is combination
therapy with pegylated interferon plus ribavirin.
This combo produces a sustained virological response (SVR) or absence of hep
C virus in the blood after six months in up to 66 per cent of patients with
hep C alone and in 40 per cent of those co-infected with HIV and hep C.
But a small number may relapse and detectable hep C virus returns.
Researchers wanted to find out whether this virological response to therapy
lasted.
They looked at the absence of hep C virus in almost 1,000 people who had taken
part in pegylated interferon trials.
Only those who were still HCV negative at the end of the trials were included
and their hep C virus levels were tested once a year for five years after
their last treatment.
Of 997 participants, 163 were hep C mono-infected and treated with pegylated
interferon (Pegasys) alone. A further 741 hep C mono-infected people were
treated with pegylated interferon plus ribavirin.
The remainder were co-infected with hep C and HIV and treated with either
pegylated interferon monotherapy or pegylated interferon plus ribavirin.
As many as 989 out of the 997 (more than 99 per cent) remained HCV RNA negative
for an average of 4.1 years after stopping therapy, an outcome the researchers
regard as a cure.
• Abstract 1 42nd EASL, Spain, 2007
New weekly hepatitis bulletin
launched
The hepatitis C resource centre at the charity Mainliners has launched a new
bulletin service. The weekly email provides bibliographic details of articles
published internationally, including research in peer reviewed journals, news
articles from newspapers, newswires and on the web.
To subscribe email Pauline : phennessy@mainliners.org.uk Enter ‘Bulletins
subscribe’ in the subject line.
Rough group sex linked to hep C in HIV positive
gay men
Group sex with more than two people was the strongest predictor of recent
hepatitis C infection in HIV positive gay men, a new study has found. Recent
(acute) hep C infection was associated with mucosal trauma leading to bleeding
during sex rather than sharing equipment to inject drugs.
Over the past few years, doctors have reported several outbreaks of what appears
to be sexually transmitted recent hepatitis C in HIV positive gay men in several
European cities. There are also reports of acute hep C infection among HIV
negative men.
In total, 111 gay men with HIV seen at one of three UK HIV clinics with acute
hep C infection (84 per cent with hepatitis C genotype 1) were included in
the analysis between 1999 and 2005.
By studying the range of hep C viruses in these men, researchers identified
seven different clusters. This suggested multiple independent forms of hep
C genotype 1 circulating among gay men living with HIV.
The men also completed questionnaires to help the researchers better understand
how the men caught hep C. Men with acute hep C reported a greater number of
sexual partners, had engaged in higher levels of high-risk behaviour and were
more likely to report sharing drugs in the preceding year.
• AIDS 21(8):983-991, 2007
