Managing HIV/HCV Co-infection – Still Much to Learn

Managing HIV/HCV Co-infection – Still Much to Learn

D r T a d d S L a z a r u s

Attending Physician, St Vincent’s Hospital (NY) and Director of Medical and Scientific Affairs,

Roche Diagnostics

(excerpted)

More than one-third of HIV patients in the US and Europe are co-infected with the hepatitis C virus (HCV). Although both diseases can be successfully managed in mono-infected patients, co-infection remains extremely problematic for many reasons, in large part due to a lack of research.  Because risk factors for both infections are similar, HCV infection is often diagnosed during or shortly after HIV diagnosis. Following an accurate diagnosis of co-infection, aggressive treatment and monitoring for both diseases is indicated, yet much remains unknown about the most effective timing, duration and potential interaction of current therapies.  The improvement of patient outcomes will continue to depend on additional research surrounding the co-evolution of diagnostic tools and therapeutic agents.

HIV/HCV co-infection rates in the US and Europe (are) as high as 35% – and an alarming 80% for intravenous (IV) drug users.  In the meantime, clinicians continue to collate and act upon what is currently known about the pathological synergy of these two diseases, with emphasis on accurate, timely diagnosis.  A lack of conclusive guidelines on the best treatment and management requires urgent attention from the scientific and clinical communities.

Does HCV co-infection expedite the development of AIDS?   Mounting evidence suggests such a trend, but  this is still subject to on-going debate.  On the other hand, researchers have concluded that HIV expedites the progression of HCV-related liver disease. co-infected patients have a three to seven times greater risk of developing cirrhosis and liver failure, and are three times more likely to die of a hepatitis-related illness than an AIDS-related illness.

Research presented in February 2004 at the 11th annual Conference on Retroviruses and Opportunistic Infections, cited end-stage liver disease (ESLD), not AIDS, as the leading cause of death in HIV/HCV co-infected patients. morbidity and mortality of AIDS may have masked the long-term effects of opportunistic infections such as HCV.  A recent increase in liver disease among co-infected patients may be evident with the (rise) of more potent HIV therapies. In the past, it is clear that co-infection compounds the challenges in treating AIDS and chronic HCV.  Consequently, there is a growing dependence on diagnostic tests to direct and monitor therapy.  Liver biopsies can be useful in assessing the level of fibrosis in HCV-infected individuals. Biopsies are extremely invasive, however, and may not be required for a physician to make the decision to treat a patient. This makes other non-invasive measures important in the treatment decision.
some researchers have concluded that patients with low CD4+ cell counts should delay HCV treatment until HAART has improved the patient’s immune status. Others speculate that earlier initiation of HAART – even before reaching 200–350 CD4+ cells – might actually decrease the incidence and progression of end-stage liver disease in (the) co-infected.  The next few years will certainly see valuable advances in treatment and management  for co-infected patients. Until then, clinicians have a variety of reliable diagnostic tools available that can help them achieve the timely identification of co-infected patients, tailor(ing) therapy to each patient with the goal of ensuring that both diseases are effectively managed.

scientific and clinical communities.

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a report by