Co-Infection Issue
What clinical parameters should be followed to allow interferon
treatment of the Hepatitis C patient with significant liver disease who is
also co-infected with HIV?
Geoffrey L. Braden, MD
Response from Adrian M. DiBisceglie, MD, 09/22/00
Patients with HIV and Hepatitis C virus (HCV) co-infection should be
followed in the same way while on therapy -- ie, with measurement of serum
aminotransferases and blood count 2 and 4 weeks after starting treatment and
then every 4 weeks, for the duration of therapy. Serum HCV RNA should be
tested after 6 months of therapy to determine the adequacy of a response. If
HCV is still detectable at that time, therapy should probably be stopped. If
HCV RNA is no longer detectable, therapy can be stopped in those infected
with HCV genotypes 2 and 3 while it should be continued for a full 12 months
in those with the more common genotype 1.
Few large controlled trials of combination therapy with interferon and
ribavirin have been done on patients with HIV co-infection. Available data
suggest that those patients with adequate CD4 counts (> 400/mL) have
rates of response similar to those who are not HIV-infected. Most clinicians
recommend that control of the HIV infection should be the first priority and
that therapy for HCV should only be considered when the HIV is stable and
under control.
Suggested Reading
Coll S, Sola R, Seoane MA, et al. Treatment of Hepatitis C, HIV-co-infected
patients with interferon: controlled study (abstract). Hepatology.
1999;30:199A.
Landau AO, Batisse DP, van Huen JP, et al. Efficacy and safety of
combination therapy with interferon alpha-2b and ribavirin for severe
chronic Hepatitis C in HIV-infected patients (abstract). Hepatology.
1999;30:367A.
Soriano V, Garcia-Samaniego J, Bravo R, et al. Interferon-alfa for the
treatment of chronic Hepatitis C in patients infected with human
immunodeficiency virus. Clin Infect Dis. 1996;23:585-591.
