The treatment of HCV infection should prevail over that of HIV infection, when possible

Where possible, treatment of infection with hepatitis C should prevail over that of the HIV infection in co-infected patients, according to experts who presented to the press the results of 'French Ribavic study evaluating the efficacy of pegylated combination therapy in patients co-infected with HIV and HCV.

A therapeutic strategy

In HIV + patients who are not yet on antiretroviral therapy and who do not have to be an emergency, the therapeutic management of hepatitis C should be a priority because, unlike HIV, the HCV is treatable, told Reuters Health Prof. Christian Perronne, Chairman of the Technical Committee on Immunization (CTV) and speaking on behalf of the study by the National Agency for AIDS Research (ANRS) group.

However, recommendations for therapeutic strategy in the management of co-infected with HIV and HCV patients will certainly be adapted to each case, he said, adding that these recommendations should be subject to the consensus conference held in Paris under the auspices of the National Agency for Accreditation and Evaluation in Health (Anaes).

Still, the treatment of HCV infection in patients co-infected with HIV now gives good results if we are to believe the results of the French test Ribavic, consistent with those obtained from other international studies.

This test, performed in more than 400 co-infected patients selected from 72 French centers, shows that the pegylated combination therapy cures 27% of patients, against 20% with conventional dual therapy. Above all, it will cure a quarter of patients infected with genotype 1 or 4 HCV, which makes patients unresponsive to standard treatment and is by far the most prevalent among co-infected patients, said Dr. Patrice Cacoub ( Pitié-Salpêtrière, Paris).

In patients infected with genotype 2 or 3 HCV, making patients susceptible to treatment, pegylated combination therapy is however not higher than the standard combination therapy, he added.

At the clinical level, the advantage of pegylated combination therapy results in a reduction of necrosis, reduced hepatic inflammation, and the lack of progression of fibrosis. This process does not otherwise collapse of CD4 and has no effect on HIV viral load, said the doctor.

The answer to 3 months predictive of the final answer

If these results are encouraging, it remains true that three-quarters of co-infected with HCV and HIV patients do not respond to this treatment. To identify responders, the authors suggest to rely on early virological response at the third month of treatment, which has a very good predictive value for sustained virologic response. Indeed, 71% of patients with negative viremia or decrease in viral load of at least 2 log will have a sustained virologic response, which is a strong argument to convince patients to continue their treatment, said Dr. Cacoub.

In contrast, those who have not got that kind of response will have no chance to heal. On behalf of those patients failing, Gerald Sanchez, Act-Up, called for the development of new molecules, accusing hint the pharmaceutical industry to ignore these patients, and the provision of structures supported by the government.

Moreover, pegylated treatment is far from being well tolerated by patients, evidenced by its interruption by 37% of patients due to its side effects. However, despite the serious concerns of the designers of the test, the tolerance was better than expected, said Professor Perronne, citing cases of depression, some digestive and skin disorders, as well as cases of mitochondrial toxicity (liver and pancreatic ) "well managed" for most.

Nearly one in three people infected with HIV are also infected with HCV. The number of co-infected patients and reach 30,000, but only 1,000 to 2,000 are treated for HCV infection. However, liver disease is the leading cause of mortality in this population, before AIDS, said Prof. Stanislas Pol (Necker Hospital, Paris), mortality is six times greater than that observed early and the population mono- infected.