ISSN 1472-4863. Published by i-Base.
Contents. 
Previous page. 
Next page.
Simon Collins, HIV i-Base
Vincent Sorriano and colleagues from the EuroSIDA cohort published an analysis in the November edition of JID of HCV genotype, viraemia and rates of spontaneous HCV clearance in HIV-positive patient in Europe and Argentina. [1]
All HCV antibody-positive (Ab+) patients the cohort with stored samples were tested for serum HCV RNA and viraemic patients were genotyped.
Of 1940 HCV Ab+ patients, 1496 (77%) were serum HCV RNA positive. Injection drug users (IDUs) were less likely to have spontaneously cleared HCV than were homosexual men (20% vs. 39%; adjusted odds ratio [OR], 0.36 [95% confidence interval {CI}, 0.24–0.53]), whereas patients positive for hepatitis B surface antigen (HBsAg) were more likely to have spontaneously cleared HCV than were those negative for HBsAg (43% vs. 21%; OR, 2.91 [95% CI, 1.94–4.38]).
Of patients with HCV viremia, 786 (53%) carried HCV genotype 1, and 53 (4%), 440 (29%), and 217 (15%) carried HCV genotype 2, 3, and 4, respectively. Higher HCV RNA levels were associated with a greater chance of being infected with HCV genotype 1 (OR, 1.60 per 1 log higher [95% CI, 1.36–1.88]).
The authors concluded that “more than three-quarters of the HCV Ab+ HIV-positive patients in EuroSIDA showed active HCV replication. Viremia was more frequent in IDUs and, conversely, was less common in HBsAg-positive patients. Of the patients with HCV viremia analyzed, 53% were found to carry HCV genotype 1, and this genotype was associated with greater serum HCV RNA levels.
An editorial comment by Raffaele Bruno and Paolo Sacchi pointed out that the high (25%) clearance rate should to be done by repeatedly using a more-sensitive test, such as a transcription-mediated amplification, rather than using single time point RNA. [2]
They explained that “In the absence of HIV infection, spontaneous HCV clearance occurs in 20% of patients. Spontaneous HCV clearance, which seldom occurs >12 months after primary infection, is less likely in men, people of black race, chronic carriers of HBV, and probably those who become infected after early childhood. Clearance of HCV does not convey immunity, because new exposure can result in reinfection. The rate of spontaneous clearance may be 2-fold higher (40%) in IDUs who clear their primary infection in the absence of HIV coinfection. Nonetheless, the majority of HCV reinfections become chronic, as seen in persons with hemophilia who used contaminated plasma derivatives before 1983. Mehta et al noted that, compared with primary infection, clearance of HCV reinfection increased among HIV-negative but not HIV-positive IDUs. [3]
“Given their low rate of spontaneous clearance and poor response rates, preservation of immune function with early antiretroviral treatment may be the best way to avoid a poor outcome of liver disease in HIV-positive patients. Further study of this strategy is warranted.”
References
1. Vincent Soriano V et al for the EuroSIDA Study Group. Spontaneous Viral Clearance, Viral Load, and Genotype Distribution of Hepatitis C Virus (HCV) in HIV-Infected Patients with Anti-HCV Antibodies in Europe. JID 2008;198:1337–1344.
http://www.journals.uchicago.edu/doi/abs/10.1086/592171
2. Raffaele Bruno and Paolo Sacchi. Spontaneous Hepatitis C Virus Clearance in HIV-Infected Patients: New Insights for Improving Management. Editorial commentary. JID 2008;198:1262–1264.
http://www.journals.uchicago.edu/doi/full/10.1086/592173
3. Mehta SH, Cox A, Hoover DR, et al. Protection against persistence of hepatitis C. Lancet 2002; 359:1478–83.
Contents. Previous page. Next page.
Top | htb | Home | Order & subscribe | Contact | Site map | Access