Vanessa Towell, Program Manager, ASHM National Policy & Education Division
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
HIV and viral hepatitis co-infection: “double trouble” for the liver
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In the Hepatitis Co-infection session today, Sanjay Bhagani from the Royal Free Hospital, London described co-infection with hepatitis C for a person living with HIV as “double trouble” for the liver.
He began by looking at the D:A:D study which examined the causes of death in 49,734 HIV-infected patients followed in the period from 1999 to 2011. In this study liver-related diseases were found to be a frequent cause of non-AIDS related death, responsible for 13% of deaths.
A second study showed that persons co-infected with HIV and HCV have liver fibrosis stages similar to those without HIV who are nearly a decade older, with progression shown to be faster even when controlling for alcohol and other co-morbidities. Bhagani also demonstrated that hepatotoxicity was more common in co-infected patients even with modern HAART.
It was not all bad news, however, with the era of Direct Acting Antiviral (DAA) based therapy now a reality. Bhagani outlined results from a number of trials looking at interferon-sparing and interferon-free therapies, which revealed similar SVR rates in co-infected patients as in mono-infected patients.
Such results have meant the EASL recommendations on the treatment of hepatitis C released in April 2014 state that the same treatment regimens can be used in HIV/HCV patients as in patients without HIV infection, as the virological results of therapy are identical. Bhagani advocated for the need for an improved cascade of care and access to treatment for people living with HIV and HCV, due to the aggressive, multi-system impact of co-infection.