Hemophilia patients co-infected with both the hepatitis C virus (HCV) and the human immunodeficiency virus (HIV) experience a four-to-eightfold increase in progression to end-stage liver disease (ESLD) when compared with those who are HIV-negative. This discovery prompted researchers to look closely at the clinical outcomes among a group of patients treated at the Hemophilia Center of Western Pennsylvania (HCWP). The study was published in the March 2009 issue of Haemophilia. The lead author was Margaret Ragni, MD, MPH, University of Pittsburgh Medical Center, HCWP.
Ragni and colleagues studied 157 hemophilia patients--137 with hemophilia A, 20 with hemophilia B—who were also infected with the hepatitis C virus (HCV); 85 were co-infected with HIV (54%) and 72 were HIV-negative. They studied the effect of HIV treatment on the subjects’ liver disease progression, focusing on highly active antiretroviral therapy, or HAART. The therapy typically includes at least three antiretroviral drugs, including a protease inhibitor, designed to curb viral replication and boost CD4+ T cell numbers in HIV patients.
Though HAART is highly effective in HIV patients, the researchers were out to show that it can also slow the serious effects associated with chronic HCV, such as ESLD and fibrosis (liver scarring) progression. Conversely, the authors pointed to other studies that have yielded potentially conflicting data, suggesting that HAART may actually increase HCV viral loads, hepatotoxicity and fibrosis progression. It should be noted that the authors cited several limitations of these contradictory studies, including lack of comparable HIV-negative control group and inability to control for risk factor for ESLD.
Of the 85 co-infected patients, 20 (23.5%) were treated with HAART while the other 65 were treated with either a single anti-retroviral therapy (ART) or not at all. The untreated patients were either unwilling or died before the therapies became available.
Results showed that the median ESLD-free survival rate was significantly longer in HIV-positive patients who were treated than in those not treated with HAART. Men treated with the HAART did not advance to ESLD on average for 30.3 years. In contrast, men in the untreated group who were HIV-negative started experiencing symptoms of ESLD at an average of 20 years. This outcome was similar to that in the HIV-negative men (20.2 years).
“In summary, the findings of this study suggest that HAART therapy is effective in slowing liver disease progression in HIV/HCV co-infected haemophilic men. This may also be true in other co-infected groups at risk for liver disease progression. Further studies are underway to evaluate the relationship of HIV viral load, HAART therapy, cytokines that cause fibrosis as well as cytokine promoter genotypes in progression of liver disease among HIV/HCV co-infected haemophilic men,” concluded study authors.
Source: Ragni MV, Nalesnik MA, Schillo R, et al. Highly active antiretroviral therapy improves ESLD-free survival in HIV-HCV co-infection. Haemophilia (2009), 15, 552 –558.