CMEonHIV.com is dedicated to providing online CME presentations (slides with voiceover) on HIV/AIDS for healthcare professionals given by local and international experts to keep you up-to-date on the ongoing developments in the field.
Conference
"Management of Dual HIV/HCV Infection" Dr. Valentina Montessori (biography) English - 2003-03-30 - 31 minutes
Summary : HIV and Hepatitis C Co-Infection: Current Challenges and Treatment.
Dual infection with both Hum Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) has emerged as an aggressive health threat in marginalized populations. Dually infected patients are not only more likely to suffer from adverse effects from their antiretroviral therapy, but also appear to experience more rapid progression of HCV to cirrhosis and end stage liver disease. HCV Infection has been noted to perhaps diminish CD4 cell improvements with antiretroviral therapy and dually infected patients have been shown to have a more rapid progression to AIDS and death than those with HIV alone. Many factors appear to influence the natural history of liver disease in co infection including exposure to other hepatoxic agents (alcohol, antiretrovirals), or perhaps immune reconstitution with anti-HIV therapy and restoration of anti-HCV immune response.
Historically, HCV/HIV co infection has primarily occurred in patients with congenital coagulation defects through the administration of contaminated blood products. Increasingly, however, needle sharing during drug use (IDU) has been responsible for the spread of infection. The prevalence of HCV in HIV-Infected IDU now approaches 90%. Sexual transmission of HCV may also play a role. Testing for HCV may be misleading. Case reports of false negative HCV antibody testing in HIV-infected individuals with low CD4 cell counts are emerging. There appears to be a role for HCV RNA testing for HCV-antibody negative patients at risk for HCV.
The standard treatments for HCV infection are rapidly evolving. Current treatment strategies include interferon (IFN) plus other antiviral agents such as ribavirin (RBV). Combination therapies produce sustained virologic response rates in 30-35% of cases. IDU are generally considered unlikely to tolerate and adhere to the necessary treatment programs and may require alternative approaches to clinical management. The newer pegylated interferon, which require only one weekly administration, may contribute to successful therapy in this challenging treatment group. Despite recent improvements in treatments for hepatitis, up to 40% of co infected patients are dying from liver disease. Liver transplant has been attempted at some research centres and may be successful in select individuals.
The effect of antiretroviral therapy on hepatic pathology has not been well studied. Similarly, the importance of liver biopsy in evaluation for possible anti-HCV therapy remains a focus for debate. A better understanding of HIV/HCV pathogenesis and treatment options in co-infection is needed if we are to significantly reduce related morbidity and mortality among marginalized populations.
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