Antiretroviral Therapy Reduces HCV Replication in Patients Co-infected with HIV

Study finds HIV suppression reduces hepatitis C viral replication over time.

Use of antiretroviral therapy in HIV patients co-infected with hepatitis C virus (HCV) can not only treat HIV, but could also limit the replication of HCV, according to the results of a recent study.

Published on July 23, 2014 in Science Translational Medicine, researchers find that suppression of HIV can also be effective in the treatment of HCV.

"There is a complex interaction of biological effects when patients are infected with both HIV and the hepatitis C virus," said study lead Kenneth Sherman, MD, PhD. "Initial response to HIV treatment results in a transient increase in HCV viral replication and evidence of liver injury. However, over time HIV suppression leads to reduced HCV replication."

Physicians working with co-infected patients in the past carried concerns that antiretroviral treatment could potentially harm the liver and threaten patient health. As a result of these beliefs, researchers examined 17 patients co-infected with HIV and HCV over a 2-year span.

As part of their HIV antiretroviral drug therapy regimen, co-infected patients received frequent evaluations and had blood samples taken to monitor minor changes in the virus so the immune response could be evaluated.

A subset of patients saw an increase in the markers of liver injury, HCV, or both during the first 16 weeks of the study.

Over a period of 18 months, it was discovered that HCV viral loads recovered to what was expected in a patient only suffering from HCV without HIV. Additionally, the researchers found that the initial liver injury resulted from effective treatment of HIV and not from toxicity.

"The drop in HCV viral levels was a big surprise and not what we necessarily expected," Dr. Sherman said.

Following the findings of the study, physicians can better assess treatment plans for patients co-infected with HIV and HCV, which is estimated to range from 4 million to 8 million people worldwide, according to Sherman.

"This process is highly modulated by down regulation of the interferon-responsive gene family," Sherman said. "The findings suggest that HIV suppression with antiretroviral medications play an important role in the management of individuals with HCV and HIV infection. It supports the concept that in those with HCV/HIV infection early and uninterrupted HIV therapy is a critical part of preventing liver disease."