AEGiS-15IAC: Impact of highly active antiretroviral therapy interruption strategies in plasma hepatitis C virus kinetics in human immunodeficiency and hepatitis C virus coinfected patients.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Impact of highly active antiretroviral therapy interruption strategies in plasma hepatitis C virus kinetics in human immunodeficiency and hepatitis C virus coinfected patients.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WeOrB1326)

Tural C, Gomez G, Martinez MA, Perez N, Fuster D, Ballesteros AL, Sirera G, Ruiz L, Schuurman R, Rey-Joly C, Planas R, Clotet B
HIV Clinical Unit, University Hospital Germans Trias i Pujol, Universitat Autonoma de Barcelona, Badalona, Spain

BACKGROUND: Structured treatment interruption (STI) approaches have been studied for their possible clinical utility in the management of HIV-infected patients(p) on highly active antiretroviral therapy (HAART). HAART modifies plasma HCV RNA levels. OBJECTIVE: To study the changes in HCV RNA plasma levels that may occur during STI approaches guided by CD4 and HIV-1 viral load in HIV/HCV coinfected p on HAART.

METHODS: P were selected from an ongoing open-label, comparative, randomised, prospective, multicenter trial described elsewhere (TIBET trial). All p with detectable HCV RNA loads at baseline (BL) who had reached 48 weeks (w) of follow up were analyzed. HIV and HCV RNA and CD4+ were performed at BL, 4, 8, 24, and 48 w. Mixed linear models were used to evaluate factors influencing HCV kinetics during off-HAART periods.

RESULTS: In 15 HCV/HIV coinfected p [mean CD4 cell count: 909± 361.8, median time on HAART: 49.2 months (36.9-53.5); HCV viral load: 5.81 log₁₀ (5.4-6.42); HCV genotypes: 1 (7p); 3 (7p) and 4 (1); hepatitis G presence at BL: 7p]. A significant but transient decrease in HCV RNA, at w 4 and 8 off-treatment, was observed (median change at w 4 and 8: -0.44 log₁₀ [range: -3.62 to 0.60] and -0.56 log₁₀ [range:-4.27 to 1.29], respectively). In 8 p this decrease was >0.5 log₁₀. However, subsequently HCV RNA increased progressively during the off-HAART period (the mean number of copies/mL of HCV RNA showed an increase of 1.22 copies/mL per month). This further increase correlated inversely with HIV RNA changes (the mean number of copies/mL of HCV RNA decreased 12.88 copies/mL per increase of 1000 copies/mL of HIV RNA) and with the presence of GB virus C. Conclusion HAART interruption leads to a significant but short lasting HCV RNA plasma decrease in half of the p. However, with prolonged follow-up plasma HCV RNA increase and correlates inversely with changes in plasma HIV RNA and the presence of GB virus C. The increase in plasma HCV RNA observed at 48 w follow-up rises serious concern regarding the safety of prolonged periods off therapy.

Keywords: AEGIS, Antiretroviral Therapy, Highly Active, Hepacivirus, Hominidae, HIV, CD4 Lymphocyte Count, Viral Load, Anti-HIV Agents, HIV Infections, Immunologic Deficiency Syndromes, Acquired Immunodeficiency Syndrome, GB virus C, HIV Protease Inhibitors, HIV Seropositivity, Antigens, CD4, Tibet, Humans, Animal, immunology

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WeOrB1326