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Resumen La infección crónica por el virus de la hepatitis C (VHC) afecta a 58 millones de personas y es una importante causa de morbimortalidad alrededor del mundo. La reinfección por VHC es un problema creciente en personas con factores de riesgo como consumo pesado de alcohol, sexo anal, sexo grupal y compartir agujas y jeringas; este tipo de infección se define como un nuevo contagio de VHC con un genotipo viral diferente al de la primera infección en un paciente luego de lograr una respuesta viral sostenida (RVS). La reinfección se presenta, en parte, debido a la ausencia de estrategias de promoción y prevención. Teniendo en cuenta estos antecedentes, se han propuesto estrategias más pragmáticas para controlar la infección por VHC y evitar la reinfección, tales como la microeliminación. En el presente artículo se presenta un caso de un paciente que presenta alteración en los marcadores de la bioquímica hepática, por lo que se solicita una prueba diagnóstica de infección por VHC y luego genotipificación viral, y se evidenció una infección por VHC genotipo 1, subgenotipo 1A. Se inició el manejo con antivirales de acción directa y se documentó una adecuada RVS12. Tres meses después el paciente regresó a consulta y en los exámenes de control se evidenció una carga viral elevada de VHC, por lo que se solicitó genotipificación y se demostró una nueva infección por VHC genotipo 4.
Abstract Chronic hepatitis C (HCV) infection affects 58 million people and is a significant cause of morbidity and mortality worldwide. HCV reinfection is a growing problem in people with risk factors such as heavy alcohol use, anal sex, group sex, and sharing needles and syringes. This type of infection is defined as a new HCV infection with a different viral genotype than the first infection in a patient after achieving a sustained viral response (SVR). Reinfection occurs, in part, due to the absence of promotion and prevention strategies. Taking this background into account, more pragmatic approaches have been proposed to control HCV infection and avoid reinfection, such as micro elimination. This article reports the case of a patient with alterations in biochemical liver markers, for which a diagnostic test for HCV infection and then viral genotyping was requested. Infection by HCV genotype 1, subgenotype 1A, was evidenced. Management with direct-acting antivirals was started, and an adequate SVR12 was documented. Three months later, the patient returned, and the control tests showed a high HCV viral load, for which genotyping was requested, showing a new HCV genotype 4 infection.
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Objective To estimate the prevalence of HIV/HCV co-infection and explore the influence factors and their interaction on HIV/HCV co-infection of patient's access to methadone maintenance treatment (MMT).Methods A face to face interviews were conducted among 750 patients at two MMT clinics in Guangxi Zhuang Autonomous Region.The questionnaires information included demographic characteristics,HIV and HCV infection status,history of drug abuse,urine test for morphine,high risk sex behaviors,needle sharing,dropped out etc.Methods of x2 test one-way,multivariate logistic regression and interactions were used to analyze the related factors of HIV/HCV co-infection.Results The study subjects included 750 participants,18.31％ (127/691) of patients were co-infected with HIV and HCV.The HIV/HCV co-infection rate in patients who shared needles with others or dropped out of treatment was 35.84％ (81/226) and 19.88％ (64/322) respectively,which were higher than those who have never shared needles or dropped out (9.89％,46/465 and 17.07％,63/369).Logistic regression analysis results showed that after adjusted for confounding factors,patients who shared needles (OR=4.50,95％CI:2.72-7.43) and dropped out of treatment (OR=1.71,95％CI:1.04-2.80) were more likely to be infected with HIV/HCV.Interaction analysis showed that sharing needles and dropping out of treatment exist additive effect on co-infection of HIV and HCV (RERI=4.21,AP=0.44,SI=1.95).Conclusions Needle sharing and dropping out of treatment are associated with HIV/HCV co-infection.Health education,psychological counseling and other measures should be taken to reduce needle sharing and dropping out of MMT.
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Objective To observe the efficacy and safety of DAAs in treating HCV patients with HIV/HCV co-infection.Method 53 patients were divided into groups based on HCV genotype. Sofosbuvir + Ledipasvir regime were used for 1b and 6a subtypes; sofosbuvir+Daclatasvir regime were used for 3a, 3b and those cannot be typed; all the patients diagnosed with cirrhosis were also administrated with ribavirin. The course of treatment for all patients is 12 weeks.Results All 53 patients completed HCV treatment, the overall SVR rate of DAAs treatment rate was 98.1%(52/53), failure rate 1.9%(1/53) ; SVR rate of DAAs treatment among non-cirrhosis patients was 100%(41/41) ; SVR rate of DAAs treatment among cirrhosis patients was 91.7%(11/12), failure rate 8.3%(1/11) . After treatment, ALT and AST levels of DAAs treatment patients were decreased (P＜0.05), while CD4 level increased (P＜0.05) . Main adverse effects are: 12 patients had gastrointestinal symptoms (22.6%) ; 6 had nausea, vomiting (11.3%), 4 had diarrhea (7.6%), 1 had mild rash (1.9%), and 5 had elevated serum total bilirubin (9.4%) . Conclusion The overall SVR rate among DAA treatment for HIV/HCV co-infected patients is high (98.1%) with broad indications. Even patients with cirrhosis are eligible. It yielded optimistic outcomes among different gene subtypes, and effectively improved liver function and CD4 level. With oral administration, short regime course, and mild adverse effects, patients can tolerate well, indicating its effectiveness and safety.
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Objective To estimate the prevalence of HIV/HCV co-infection and explore the influence factors and their interaction on HIV/HCV co-infection of patient's access to methadone maintenance treatment (MMT).Methods A face to face interviews were conducted among 750 patients at two MMT clinics in Guangxi Zhuang Autonomous Region.The questionnaires information included demographic characteristics,HIV and HCV infection status,history of drug abuse,urine test for morphine,high risk sex behaviors,needle sharing,dropped out etc.Methods of x2 test one-way,multivariate logistic regression and interactions were used to analyze the related factors of HIV/HCV co-infection.Results The study subjects included 750 participants,18.31％ (127/691) of patients were co-infected with HIV and HCV.The HIV/HCV co-infection rate in patients who shared needles with others or dropped out of treatment was 35.84％ (81/226) and 19.88％ (64/322) respectively,which were higher than those who have never shared needles or dropped out (9.89％,46/465 and 17.07％,63/369).Logistic regression analysis results showed that after adjusted for confounding factors,patients who shared needles (OR=4.50,95％CI:2.72-7.43) and dropped out of treatment (OR=1.71,95％CI:1.04-2.80) were more likely to be infected with HIV/HCV.Interaction analysis showed that sharing needles and dropping out of treatment exist additive effect on co-infection of HIV and HCV (RERI=4.21,AP=0.44,SI=1.95).Conclusions Needle sharing and dropping out of treatment are associated with HIV/HCV co-infection.Health education,psychological counseling and other measures should be taken to reduce needle sharing and dropping out of MMT.
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Introducción: Las terapias contra el virus de la Hepatitis C han evolucionado vertiginosamente con el desarrollo de los antivirales de acción directa (AADs). Los nuevos regímenes han conseguido igualar las tasas de respuesta al tratamiento en los monoinfectados y los coinfectados con VIH, una población tradicionalmente difícil de tratar debido a la elevada morbimortalidad hepática y sistémica, reacciones adversas e interacciones medicamentosas. Objetivo: Analizar las opciones farmacoterapéuticas más modernas disponibles para los pacientes coinfectados con VIH y VHC, con énfasis en los nuevos antivirales de acción directa, a fin de ofrecer una herramienta útil en el abordaje terapéutico en estos pacientes. Material y métodos: Se revisaron artículos originales, ensayos clínicos y revisiones sistemáticas hasta septiembre de 2016, bases de datos internacionales de interacciones medicamentosas y Guías de Práctica Clínica actualizadas. Desarrollo: Las terapias contra el virus de la Hepatitis C (VHC) han evolucionado vertiginosamente con el desarrollo de los antivirales de acción directa (AADs). Los nuevos regímenes han conseguido igualar las tasas de respuesta al tratamiento en los monoinfectados y los coinfectados con VIH, una población tradicionalmente difícil de tratar que, además, asociaba una elevada morbimortalidad hepática y sistémica, más reacciones adversas y complejas interacciones medicamentosas. Conclusiones: En este nuevo escenario es fundamental dedicar esfuerzos a identificar el elevado porcentaje de infectados no diagnosticados, potenciales interacciones, especialmente con fármacos para patologías asociadas al envejecimiento de los pacientes, reacciones adversas a medio-largo plazos y desarrollo de resistencias, además de garantizar la cobertura universal en todos los contextos clínicos(AU)
Introduction:Therapies for hepatitis C virus (HCV) have rapidly evolved with the development of direct-acting antiviral agents. New regimens, achieve an equate response rates to treatment in cases of HCV mono-infected and HIV/HCV co-infected; a population traditionally difficult to treat due to a high hepatic and systemic morbidity-mortality, adverse reactions and drug interactions. Objective: To analyse the current Pharma-therapeutic options available for co-infected HIV-HCV patients, with emphasis I the new direct-acting antiviral agents, in order to offer a useful tool for the therapeutic approach in these patients. Material and Methods: Original articles, clinical studies and systematic reviews until September 2016 were carried out, as well as international drug interactions databases and updated Practical Guidelines. Development: Therapies for hepatitis C virus (HCV) have rapidly evolved with the development of direct-acting antiviral agents. New regimens achieve an equate response rates to treatment in HCV mono-infected and HIV/HCV co-infected; a population traditionally difficult to treat, which also associate a high hepatic and systemic morbidity-mortality, adverse reactions and complex drug interactions. Conclusions: In this new scenario efforts must be addressed to identify the high percentage of undiagnosed patients; potential interactions, especially with drugs related with patient aging; medium and long-term adverse reactions and development of drug resistances, as well as to guarantee universal coverage in all clinical contexts(AU)
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Humans , Male , Female , Comorbidity , HIV Infections/therapy , Hepatitis C, Chronic/therapy , Hepacivirus/pathogenicity , Coinfection/epidemiologyABSTRACT
Objective To evaluate liver injury in patients with hepatitis C virus (HCV)/human immunodeficiency virus (HIV) coinfection in Dehong Prefecture,Yunnan Province.Methods A total of 4 784 HIV-infected patients were enrolled in this study.Baseline aspartate aminotransferase (AST),alanine aminotransferase (ALT) and AST-to-platelet ratio index (APRI) before HIV treatment were collected to analyze the relationship between HCV infection and liver injury.Data were analyzed by x2 test and nonparametric rank sum test when appropriate.Risk factors for liver injury were analyzed by multivariate Logistic regression.Results Totally 4 784 patients were included,of which 30.2％ (1 447/ 4 784) were anti-HCV positive,41.7％ (1 996/4 784) had liver dysfunction and 13.3％ (636/4 784) had liver cirrhosis.Prevalence of liver dysfunction (61.1％,821/1 343) and cirrhosis (24.1 ％,323/1 343) were significantly higher among anti-HCV-positive patients than anti-HCV-negative patients (31.5％,974/3 092,X2=341.223,P＜0.01;7.5％,231/3 092,X2=235.457,P＜0.01,respectively).Multivariate Logistic regression showed that anti-HCV-positive patients suffered significantly higher risk of liver dysfunction (OR=1.99,95％ CI:1.66-2.37) and liver cirrhosis (OR=2.41,95％CI:1.90-3.04).Conclusion Patients with HCV/HIV in Dehong Prefecture coinfection had a higher risk for liver injury.
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Objective To comparatively analyze the HIV disease progression and the death situa-tion between injecting drug users (IDUs) with HIV infection and those with HIV/HCV co-infection.Meth-ods The counts of CD4+T cells were collected through a retrospective study and the data about death situa-tion were collected with follow-up cards from 2006 to 2014 .A statistical analysis was conducted for the two groups .Results Among the 175 cases with HIV infection , the average value of primary CD 4+T cell counts was 370 cell/μl and 25.71%of them, primary CD4+T cell counts were less than 200 cell/μl.The average change rate of CD4+T cell counts was -1.50 cell/μl in month.The annual mortality rate was 18.18%. Among the 325 cases with HIV/HCV co-infection, the average value of primary CD4+T cell counts was 420 cell/μl and 20.45%of them, primary CD4+T cell counts were less than 200 cell/μl.The average change rate of CD4+T cell counts was -2.76 cell/μl in month.The annual mortality rate was 32.14%.The differ-ences between the groups were significant (P<0.05).Conclusion Compared with patients with HIV infec-tion, those with HIV/HCV co-infection showed significantly decreased CD 4+T cell counts , resulting in a faster disease progression and a faster death .It was urgent for the management department to work out HIV prevention and therapeutic measures .
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Background: Co-infection by human immunodeficiency and hepatitis C viruses (HIV/HCV) is common and results in significant morbidity and mortality despite effective antiretroviral therapies (ART). Method: A retrospective and prospective evaluation of the efficacy and safety of pegylated interferon alfa 2a/2b plus ribavirin (PEG-IFN/RBV) in consecutive HIV/HCV co-infected patients treated in real life clinical practice in Malaysia. Results: Forty-five HIV/HCV co-infected patients with a median age (interquartile range, IQR) of 41 years (37; 47) were assessed for treatment with PEG-IFN/RBV. All except one are of male gender and the most common risk behaviour was injecting drug use. At baseline 75.5% was on ART and the median (IQR) CD4 count was 492 cells/µl (376; 621). The HCV genotypes (GT) were 73 % GT3 and 27% GT1. Liver biopsies in forty patients showed 10% had liver cirrhosis and another 50% had significant liver fibrosis. The treatment completion rate was 79.5% with 15.9% dropped out of treatment due to adverse effects (AE) or default and 4.6% due to lack of early virological response. The AE causing premature discontinuations were neuropsychiatric and haematological. The overall sustained virological response (SVR) was 63.6% with a trend towards higher SVR in GT3 compared with GT1 (71.9% vs. 41.7%; p=0.064). In patients with bridging fibrosis plus occasional nodules or cirrhosis on liver biopsy, the SVR was significantly lower at 20% (p=0.030) compared to those with milder fibrosis. Conclusion: HIV/HCV co-infected patients can be successfully and safely treated with PEG-IFN/RBV achieving high rates of SVR except in cirrhotic patients.
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HIV , HepacivirusABSTRACT
AIM: To evaluate changes in liver histology in patients with human immunodeficiency virus/hepatitis C virus coinfection non-responders to a suboptimal Interferon+Ribavirine regimen. MATERIALS AND METHODS: We investigated 49 patients with two sequential liver biopsies: 18 were non-responders to Interferon+Ribavirine treatment (Group hepatitis C virus Rx) administered after the 1st liver biopsy who underwent a 2nd liver biopsy after a median period of 3.92 year and 31 were patients who remained untreated for hepatitis C virus disease (Group hepatitis C virus untreated) after the 1st liver biopsy because of refusal and underwent a 2nd liver biopsy after a median period of 5.05-years. Most patients in both groups were under highly active antiretroviral therapy. At the time of 1st liver biopsy similar degrees of necro-inflammation, fibrosis and steatosis were observed in both groups. Changes in liver lesions between 1st and 2nd liver biopsys were adjusted for different intervals between liver biopsys by a mathematic formula. RESULTS: Liver fibrosis did not change in 88.9% of patients in Group hepatitis C virus Rx and in 77.4% in Group hepatitis C virus untreated. A marked deterioration in liver fibrosis was observed in 5 (16%) patients in Group hepatitis C virus untreated and in none in Group hepatitis C virus treated. Necro-inflammation and steatosis remained substantially unchanged in both groups. CONCLUSION: Liver histology remained substantially unchanged in human immunodeficiency virus/hepatitis C virus patients non-responder to anti-hepatitis C virus therapy over 4 years observation, suggesting an effective anti-hepatitis C virus early treatment for all hepatitis C virus/human immunodeficiency virus coinfected patients who can reasonably tolerate therapy. .
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Adult , Female , Humans , Male , Antiviral Agents/therapeutic use , Coinfection , HIV Infections/pathology , Hepatitis C/pathology , Interferon-alpha/therapeutic use , Liver Cirrhosis/virology , Liver/pathology , Ribavirin/therapeutic use , Antiviral Agents/adverse effects , Biopsy , Coinfection/pathology , Coinfection/virology , Disease Progression , HIV Infections/complications , HIV Infections/drug therapy , Hepatitis C/complications , Hepatitis C/drug therapy , Interferon-alpha/adverse effects , Liver Cirrhosis/pathology , Liver/virology , Ribavirin/adverse effects , Severity of Illness IndexABSTRACT
OBJECTIVES: Progression of hepatic fibrosis is accelerated in patients co-infected with human immunodeficiency virus and hepatitis C virus compared to hepatitis C virus mono-infected patients. This study aimed to compare ultrasound features and selected clinical and biochemical variables between patients with human immunodeficiency virus/hepatitis C virus co-infection (n = 16) versus hepatitis C virus mono-infection (n = 16). METHODS: Each patient underwent abdominal ultrasound, and a specific evaluation was performed in order to detect findings consistent with chronic liver disease. Characterization of spleen size, liver structural pattern, diameter of the portal, spleen, and mesenteric veins was based on classical ultrasound parameters. Propensity score was used for control of selection bias and performed using binary logistic regression to generate a score for each patient. The Fisher and Mann-Whitney tests were used to evaluate categorical variables and continuous variables, respectively. RESULTS: On univariate analysis right hepatic lobe size was larger in human immunodeficiency virus/hepatitis C virus patients (157.06 ± 17.56 mm) compared to hepatitis C virus mono-infected patients (134.94 ± 16.95 mm) (p = 0.0011). The left hepatic lobe was also significantly larger in human immunodeficiency virus/hepatitis C virus patients Cirrhosis (115.88 ±22.69 mm) versus hepatitis C virus mono-infected patients (95.06 ±24.18 mm) (p= 0.0177). Also, there was a strong correlation between hepatomegaly and co-infection (p=0.005). CONCLUSION: Human immunodeficiency virus infection was the primary variable influencing liver enlargement in this population. Hepatomegaly on ultrasound was more common among cirrhotic human immunodeficiency virus/hepatitis C virus co-infected patients than among cirrhotic hepatitis C virus mono-infected patients. This aspect is very important in the management of human immunodeficiency virus/hepatitis C virus co-infected patients, because screening for hepatocellular carcinoma is necessary in this population.
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Female , Humans , Male , Middle Aged , Coinfection , HIV Infections , Hepatitis C, Chronic , Hepatomegaly , Liver Cirrhosis , Analysis of Variance , Biopsy , Case-Control Studies , Coinfection/pathology , Disease Progression , HIV Infections/complications , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/pathology , Hepatomegaly/pathology , Liver Cirrhosis/pathology , Organ Size , Severity of Illness IndexABSTRACT
INTRODUCTION: The aim of this study was to evaluate the therapeutic response of hepatitis C in patients coinfected with human immunodeficiency virus (HIV-1). METHODS: A retrospective study of 20 patients coinfected with HIV-1/HCV who were treated in the outpatient liver clinic at the Sacred House of Mercy Foundation Hospital of Pará (Fundação Santa Casa de Misericórdia do Pará - FSCMPA) from April 2004 to June 2009. Patients were treated with 180µg PEG interferon-α2a in combination with ribavirin (1,000 to 1,250mg/day) for 48 weeks. The end point was the sustained virological response (SVR) rate (HCV RNA negative 24 weeks after completing treatment). RESULTS: The mean age of the patients was 40±9.5 years, of which 89% (n=17) were male, and the HCV genotypes were genotype 1 (55%, n=11/20), genotype 2 (10%, n=2/20) and genotype 3 (35%, n=7/20). The mean CD4+ lymphocyte count was 507.8, and the liver fibrosis stages were (METAVIR) F1 (25%), F2 (55%), F3 (10%) and F4 (10%). The early virological response (EVR) was 60%, the end-of-treatment virological response (EOTVR) was 45% and the SVR was 45%. CONCLUSIONS: The median HCV viral load was high, and in 85% of cases in which highly active antiretroviral therapy (HAART) was used, none of the patients with F3-F4 fibrosis responded to treatment. Of the twenty patients treated, 45% achieved SVR and 45% achieved EOTVR. Studies that include cases from a wider region are needed to better evaluate these findings.
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Adult , Female , Humans , Male , Antiviral Agents/therapeutic use , Coinfection/virology , HIV Infections/drug therapy , Hepatitis C/drug therapy , Interferon-alpha/therapeutic use , Polyethylene Glycols/therapeutic use , Ribavirin/therapeutic use , Antiretroviral Therapy, Highly Active , Drug Therapy, Combination , Genotype , HIV Infections/complications , Hepatitis C/complications , Retrospective Studies , RNA, Viral , Recombinant Proteins/therapeutic use , Treatment OutcomeABSTRACT
OBJETIVO: Determinar la evolución clinico-inmunológica de pacientes coinfectados con los virus VIH-VHC, atendidos en el Instituto de Medicina Tropical Dr. Pedro Kourí, entre los años 2002-2006. MÉTODOS: Se realizó un estudio de cohorte prospectivo donde fueron incluidos 170 pacientes: 40 coinfectados con los virus VIH-VHC (expuestos) y 130 infectados con el VIH (no expuestos). RESULTADOS: La edad media fue de 33,4 años (34,1 años en los pacientes expuestos y 33,4 en los no expuestos). Predominaron el sexo masculino y el color blanco de la piel (143: 84,1 por ciento y 94: 55,3 por ciento, respectivamente). Los niveles de transaminasas glutamicooxalacética (TGO), glutámico-pirúvica (TGP) y deshidrogenasa láctica (LDH) fueron más elevados en los pacientes coinfectados (p<0,05) que en los monoinfectados. El tiempo medio de diagnóstico del VIH se relacionó de manera significativa con el diagnóstico de VHC y con el SIDA. Hubo menos casos con conteo de CD4+ por debajo de 200 cel/mm³ en los expuestos que en los no expuestos y no existieron diferencias significativas cuando se compararon los grupos según los niveles de CD4+ mayores de 200 cel/mm³. No hubo diferencias significativas entre los valores medios de CD4+ según el tiempo de diagnostico del VIH entre ambos grupos de pacientes. CONCLUSIONES: El daño tisular reflejado por un aumento del nivel de transaminasas (TGO y TGP) y de deshidrogenasa lßctica (LDH) es más elevado en los pacientes infectados con HVC, y la coinfección por el VHC no se relaciona con un mayor deterioro inmunológico ni con un aumento de la frecuencia del SIDA
OBJECTIVE: To determine the immunological-clinical course of HIV-CHV coinfected patients, seen in the Pedro Kourí Tropical Medicine Institute between 2002-2006 years. METHODS: A prospective study was conducted including 170 patients: 40 coinfected with HIV-CHV virus (exposed) and 130 infected by HIV virus (no exposed). RESULTS: The mean age was of 33,4 years (34,1 years in exposed patients and 33,4 in those no exposed). There was predominance of white male sex (143: 84,1 percent and dd94: 55,3 percent, respectively. The glutamic-oxalacetic transaminase (GOT), glutamic-pyruvic (GPT) and lactic dehydrogenase (LDH) levels were higher in coinfected patients (p < 0,05) than those monoinfected. The mean time of HIV diagnosis was significantly related to the C hepatitis virus (CHV) and t AIDS. There were less cases with a CD4+ count under 200 cel/mm3 in those exposed that in those no exposed and there were not significant differences when were compared with the groups according to the DC4+ over 200 cel/mm3. Also, there were not marked differences among the mean values of CD43 according to the HIV diagnosis time among both groups of patients. CONCLUSIONS: The tissue damage reflected by an increase of transaminase levels (GOT and PGT) and of lactic dehydrogenase (LDH) is higher in the C hepatitis virus and the coinfection by CHV it is neither related to the great immunologic deterioration nor an increase of AIDS frequency
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Humans , Male , Adult , Hepacivirus/pathogenicity , HIV Infections/complications , Cohort Studies , Prospective StudiesABSTRACT
A polineuropatia desmielinizante inflamatória cônica possui forte associação com a infecção pelo HIV e HCV. Uma rara associação entre PDIC e o tratamento da hepatite C com interferon peguilado alfa foi descrita recentemente. Nós descrevemos o primeiro caso de polineuropatia desmielinizante inflamatória crônica em um paciente branco, sexo masculino infectado por HIV e HCV associado a interferon peguilado alfa 2b. O paciente recuperou-se completamente após o uso de imunoglobulina hiperimune endovenosa. Infectologistas e hapatologistas devem estar atentos à esta rara e grave associação, que exige imediata descontinuação da droga e tratamento precoce.
Chronic inflammatory demyelinating polyneuropathy has a strong association with HIV and HCV infection. A rare association between chronic inflammatory demyelinating polyneuropathy and hepatitis C treatment with pegylated interferon alpha was described recently. We described the first case of chronic inflammatory demyelinating polyneuropathy associated with pegylated interferon alpha 2b in a white man infected with HIV and HCV. The patient recovered completely with the use of intravenous hyperimmune immunoglobulin. Infectologists and hepatologists should be alert regarding this rare and serious association, which requires immediately drug discontinuation and early treatment.
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Humans , Male , Middle Aged , Antiviral Agents/adverse effects , Interferon-alpha , Immunoglobulins, Intravenous/therapeutic use , Polyethylene Glycols/adverse effects , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/chemically induced , HIV Infections/complications , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/drug therapy , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/drug therapyABSTRACT
The potential impact of the hepatitis C virus (HCV) on clinical, immunological and virological responses to initial highly active antiretroviral therapy (HAART) of patients infected with human immunodeficiency virus (HIV) is important to evaluate due to the high prevalence of HIV-HCV coinfection. A historical cohort study was conducted among 824 HIV-infected patients starting HAART at a public referral service in Belo Horizonte, Brazil, to assess the impact of HCV seropositivity on appearance of a new AIDS-defining opportunistic illness, AIDS-related death, suppression of viral load, and an increase in CD4-cell count. A total of 76 patients (9.2 percent) had a positive HCV test, 26 of whom (34.2 percent) had a history of intravenous drug use. In multivariate analysis, HCV seropositivity was associated with a smaller CD4-cell recovery (RH=0.68; 95 percent CI [0.49-0.92], but not with progression to a new AIDS-defining opportunistic illness or to AIDS-related death (RH=1.08; 95 percent CI [0.66-1.77]), nor to suppression of HIV-1 viral load (RH=0.81; 95 percent CI [0.56-1.17]) after starting HAART. These results indicate that although associated with a blunted CD4-cell recovery, HCV coinfection did not affect the morbidity or mortality related to AIDS or the virological response to initial HAART.