Journal Article

Sustained Virological Response after Early Antiviral Treatment of Acute Hepatitis C Virus and HIV Coinfection

Julian Schulze zur Wiesch, Dorothea Pieper, Ingrid Stahmer, Thomas Eiermann, Peter Buggisch, Ansgar Lohse, Joachim Hauber and Jan van Lunzen

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 49, issue 3, pages 466-472
Published in print August 2009 | ISSN: 1058-4838
Published online August 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/600399
Sustained Virological Response after Early Antiviral Treatment of Acute Hepatitis C Virus and HIV Coinfection

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Background. Limited data exist describing the clinical outcome and immunological response primed during simultaneously acquired acute hepatitis C virus (HCV) and human immunodeficiency virus (HIV) coinfection. We present detailed clinical and immunological analysis of 3 individuals after concomitant infection with acute HCV and primary HIV.

Methods. In addition to longitudinal clinical parameters, virus-specific T cell responses were assessed using Elispot, standard proliferative (carboxyfluorescein diacetate succinimidyl ester), and in vitro CD4+T cell assays.

Results. In all patients, anti-HCV treatment was started with pegylated interferon-α, and antiretroviral therapy was coadministered early during primary infection. HCV viremia was cleared under therapy with pegylated interferon-α in all 3 cases. In 2 patients, HIV replication was contained even after antiretroviral therapy had been interrupted, which was associated with strong HIV-specific CD8+and CD4+T cell responses. In these 2 patients, multispecific HCV CD4+T cell responses could also be detected. No HCV-specific CD4+T cell responses were detected in the third patient, who also had the lowest nadir CD4+cell count during primary HIV infection (<200 cells/µL).

Conclusions. Anti-HIV and -HCV therapy should be considered early in cases of concomitant acute HCV and HIV coinfection, because succcessful therapy of HCV viremia seems possible even during primary HIV infection. HCV-specific T cell immunity is generated during primary HIV infection and can be preserved by HCV treatment. However, the optimal treatment algorithm needs to be established in prospective, randomized trials.

Journal Article.  4131 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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