Since the introduction of highly active combination drug therapy for HIV, liver failure attributable to infection with the hepatitis C virus (HCV) has become a leading cause of death among those infected with the virus that causes AIDS.
Now a multi-center study has found that the newest treatment for patients infected with HCV alone also helps those infected with both pathogens by significantly improving the clearance of HCV from the bloodstream. The report appears in the July 29 New England Journal of Medicine.
"Hepatitis C has become the new opportunistic infection among HIV-infected patients," says Raymond Chung, MD, director of the Center for Liver Disorders in the Gastrointestinal Unit at Massachusetts General Hospital (MGH), who led the study. "About 25 percent of those with HIV are coinfected with HCV, largely because these viruses share modes of transmission. The problem is immense and growing. (Note: Dr. Raymond Chung was the recipient of HFI’s Career Development Research Award in 2000)
Chung notes that what had been the standard treatment for those infected with HCV only – interferon and ribavirin – was not effective for patients also infected with HIV. In those with both viruses, control of HCV levels in the blood was diminished and side effects were more pronounced, leading many patients to stop therapy. Recently, the FDA has approved a treatment for HCV-only infection using a chemically modified form of interferon, which keeps the drug active in the body for a longer period of time. The current study was designed to investigate whether this new approach could safely improve treatment success in those infected with both viruses.
Researchers at 21 centers around the U.S. enrolled patients infected with both HCV and HIV who had not previously received interferon treatment. The 133 enrolled patients were randomized to receive either the newer drug peginterferon and ribavirin or the previous standard treatment of interferon and ribavirin. Halfway through the 48-week study period, blood tests were taken to see whether HCV blood levels had dropped in response to therapy. Participants who did not show a viral response had liver biopsies to determine whether the treatment had reduced liver damage. Those who exhibited either viral clearance or improved liver biopsy findings continued with the experimental treatment, while those with no response discontinued therapy.