[40] HIV AND HEPATITIS: A STORY OF SCRAMBLED LETTERS

1st International AIDS Society Conference on HIV Pathogenesis and Treatment

Buenos Aires, Argentina - July 8-11, 2001

[TITLE:] HIV AND HEPATITIS: A STORY OF SCRAMBLED LETTERS

[AUTHOR(S):] Francesca J. Torriani
University of California, San Diego, UCSD Treatment Center, San Diego, USA

IAS Conf HIV Pathog Treat 2001 Jul 8-11;1st: Abstract No. 40

[ABSTRACT:] The prevalence of HCV infection in HIV-infected individuals ranges between 10 and 80% depending on the mode of transmission (sexual or parenteral). In controlled HIV/HCV co-infection, similar to HCV monoinfection, less than 15% of individuals will spontaneously clear the HCV virus and at least 70% will develop active chronic HCV disease. While a negative effect of HCV infection on HIV progression has not been definitively excluded, co-infection with HIV results in more aggressive liver disease and faster progression to cirrhosis, end stage liver disease and liver related deaths. In addition, the liver damage appears to predispose these patients to hepatotoxicity to antiretroviral drugs, thus potentially limiting the use of some antiretroviral combinations. Recent metabolic studies suggest that glucose and lipid metabolism may also be affected.

The life expectancy of HIV-infected persons has dramatically improved since the widespread use of potent antiretroviral therapy and many clinicians are considering treating HCV infection in HIV/HCV co-infected individuals. Results from small studies indicate that sustained virologic responses with interferon and ribavirin are similar to those observed in HCV monoinfection when HIV infection is immunologically and virologically controlled. Large randomized studies are being conducted worldwide comparing thrice weekly interferon plus ribavirin to pegylated interferons, that are expected to yield results in the next two years.

Meanwhile, more studies should focus on the mechanisms involved with sexual transmission, on HCV virus and host factors leading to the persistence of this infection, on plasma and hepatic viral dynamics in acute infection and during treatment. Finally, because the available therapies are scarce at this time, new drug combinations should be evaluated.

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