The long-term outlook for HIV-positive individuals coinfected with hepatitis C virus may be much better than previously thought, according to a study* of the natural history of the HIV/hepatitis C coinfection. This was one of two studies suggesting cautious optimism for the long-term prognosis of people coinfected with HIV and hepatitis C virus presented in June to the Fourth International Workshop on HIV and Hepatitis C Coinfection in Madrid.
Although it is accepted that infection with HIV speeds up the course of hepatitis C disease there is still scant information available on the long-term risk of progression to cirrhosis, liver failure or liver cancer, all of which are termed `end-stage liver disease` in patients with HIV and hepatitis C virus – particularly those who have not received treatment for their hepatitis C infection, or have been unable to clear it following treatment.
In this study from Italy, investigators found that over 20 years after infection with HIV, the vast majority of patients with hepatitis C coinfection, most of whom had never received treatment for their hepatitis C virus, were still alive and that the probability of progressing to end-stage liver disease was less than 1-in-11, which is much better than previously thought.
A second study**, from Germany, found that there are significant benefits of HIV treatment in reducing the impact of hepatitis C-related liver damage, adding weight to the recommendations from the recently revised British HIV Association (BHIVA) treatment guidelines that early initiation of antiretroviral therapy is especially important in people coinfected with HIV and hepatitis C virus.
The investigators found that there was no difference in the degree of liver damage between the 57 patients in the study coinfected with HIV and hepatitis C virus who received antiretroviral therapy and the 84 study participants who were infected with hepatitis C alone and concluded that their study confirms earlier research showing that coinfected patients taking antiretroviral therapy have their rate of liver disease slowed.
However, a further study*** from Italy found that an epidemic of sexually transmitted hepatitis C virus amongst HIV-positive gay men appears to be gaining a foothold in southern Europe. Investigators in Milan have found convincing evidence of sexual transmission of hepatitis C amongst HIV-positive gay men in the city, particularly after 2006, following reports from the UK, Netherlands and Germany. Although there are high rates of HIV/hepatitis C coinfection in southern Europe, this is due to injecting drug use, and prior to this study there had been little evidence of sexual transmission of hepatitis C.
Out of a total of 272 gay or bisexual men who received HIV care in the city between 1996 and the end of 2007, 21 men were found to have been infected with hepatitis C. There were no infections in the period before 2000, but three men became infected with hepatitis C between 2001 and 2005. The outbreak gathered pace after 2006 with 18 new infections by the end of 2007, matching the epidemiology of sexually transmitted hepatitis C infection in HIV-positive gay men in northern Europe.
Notably, a third of the coinfected men were also diagnosed with syphilis at the time of their hepatitis C diagnosis, and none of the cases seen before 2005 involved concurrent syphilis infection. This cluster of hepatitis C and syphilis infections in 2006-07 could indicate the transmission of these infections within sexual networks, the investigators suggest. This is supported by evidence from northern Europe, were high rates of sexually transmitted infections, notably syphilis, have also been seen in HIV-positive gay men with recent hepatitis C infections.
The investigators recommend that sexually active HIV-positive gay men should be considered for regular hepatitis C screening. Such screening, along with regular liver function tests, is already recommended in the early detection of hepatitis C coinfection.
With Thanks to aidsmap.com
