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S11 The Treatment of Chronic HCV Infection in HIV-Infected Persons. M. SULKOWSKI*. Johns Hopkins Univ., Baltimore, MD.
HCV treatment is recommended for patients at the greatest risk for progression to cirrhosis, characterized as elevated ALT, detectable HCV RNA, and histologic findings of portal or bridging fibrosis or at least moderate degrees of inflammation or necrosis (NIH Consensus Statement, 1997). Therapy with interferon alfa (IFN) or IFN plus ribavirin (RBV) may yield sustained virologic eradication and, even in the absence of complete virologic response, may delay liver disease progression. However, these agents have not been well studied in HIV/HCV co-infected patients. Soriano et al. reported that 18 of 90 (20%) HIV-infected patients achieved a sustained virologic response after IFN monotherapy. Response was associated with CD4 cell count > 500 cells/mm3 and IFN appeared reasonably well tolerated. Recently, among HIV-uninfected persons, randomized, placebo-controlled clinical trials have clearly demonstrated the safety and enhanced antiviral efficacy of IFN/RBV compared to IFN alone for the treatment of chronic HCV infection. While studies are currently underway, no published data are available addressing the safety and efficacy of IFN/RBV in HIV-infected persons. The major toxicity of oral RBV is a reversible, dose-dependent, hemolytic anemia. RBV may also antagonize the anti-HIV activity of pyrimidine 2', 3'-dideoxynucleosides (ZDV, DDC, and D4T). Nonetheless, the superior efficacy of IFN/RBV among HIV-uninfected persons is compelling, and HCV treatment may be beneficial for some co-infected persons. Clinical research is urgently needed to define the safety, efficacy and cost-effectiveness of HCV treatment strategies for HIV-infected persons, including the use of investigational agents such as long-acting, pegylated (PEG) interferons, which allow once weekly administration and may be more effective than standard IFN.
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