Treatment of acute C hepatitis in HIV infected patients

Abstract number: 1133_34

Audagnotto S., De Rosa F.G., Bargiacchi O., Garazzino S., Veronese L., Cariti G., Di Perri G.

Objective:  

Chronic C hepatitis is an important cause of morbidity and mortality in patients with HIV infection. Although treatment with pegylated interferon (PEG-IFN) and ribavirin has significantly improved the outcome, HCV co-infection remains a major threat for HIV patients. Recent findings suggest that treatment of HCV infection in its acute phase may be very successful, but no data are available on acute infection in HIV-positive patients. We report four HIV-positive patients with acute C hepatitis treated with PEG-IFN alpha-2b for 12 weeks.

Methods:  

Inclusion criteria were documented seroconversion, positive HCV-RNA and elevated ALT levels with a known risk factor in the preceding 6 month in patients with HIV infection, naïve for antiretroviral therapy, with the CD4 cell count >400/mm³. Patients received PEG-IFN alpha-2b ranging from 1.1 to 1.5 mg/Kg once weekly for 12 weeks. ALT, CD4 cell count, HCV-RNA and HIV-RNA measurements were made at week 0, 1, 2, 3, 4, 8, 12, and 24 weeks after the end of treatment. The primary endpoint was the sustained viral response (SVR). Monitoring of critical HIV immuno-virological parameters was also performed.

Results:  

Two patients had HCV genotype 1. Risk factors for HIV and HCV transmission were intravenous drug use (50%) and sexual exposure (50%). At baseline, median HCV-RNA level was 1.478.000 copies/mL (range: 3.200–7.600.000); the median HIV-RNA level was 50.000 copies/mL (range: 20.000–2.600.000). Treatment was given within 120 days (range: 30–120) of the ALT level peak. At week 4 HCV-RNA was undetectable in all patients but one, who never had a negative HCV-RNA. SVR was achieved in three patients. The non responder patient received a lower interferon dosage. At week 1 there was a mean decrease of HIV-RNA of 0.6 log10, which did not change until the end of therapy. No significant decrease of CD4 cell count was observed.

Conclusions:  

Treatment with PEG-IFN administered for 12 weeks is effective, well tolerated and is not associated with any significant change of HIV infection parameters. As also seen in other settings, higher PEG-IFN dosage may be associated with SVR. According to recent studies the treatment of acute C hepatitis can provide a unique opportunity for a sustained control of HCV infection in HIV patients.