Historically, and for unknown reasons, patients with hepatitis C are less likely to receive so-called highly active antiretroviral therapy, or HAART, than are those without hepatitis C, according to the report published in the July 10 issue of The Journal of the American Medical Association (JAMA), a theme issue on HIV/AIDS. Patients with both hepatitis C and HIV infections experience relatively high rates of AIDS and death. In the Hopkins study, these patients did just as well on HAART as patients with HIV alone.
"Among patients prescribed HAART, we found no evidence that hepatitis C virus infection substantially alters the virologic or immunologic response to potent antiretroviral therapy. Hepatitis C virus infection should not be a barrier to aggressive antiretroviral therapy in HIV patients," said lead author Mark Sulkowski, M.D., assistant professor of medicine in the division of infectious diseases, and medical director of the Center for Viral Hepatitis at Hopkins.
Scientists have known for some time that HIV can make hepatitis C worse and increase the progression of hepatitis C-related liver disease, but the verdict was out on how, and to what degree, hepatitis C affects HIV. In the United States and Europe, an estimated 16 percent to 30 percent of those with HIV also have hepatitis C due to shared methods of transmission, such as injection drug use. In Baltimore and other major cities, these numbers can be as high as 50 percent or more.
The Hopkins study included 1,995 patients enrolled between January 1995 and January 2001 at the Moore HIV Clinic of The Johns Hopkins Hospital. All were HIV positive but did not have AIDS when they entered the study, and 45 percent also had hepatitis C infection. Clinic visits and laboratory evaluations were performed at regular intervals. Patients given HAART were seen four weeks after starting treatment, and then every 12 weeks for at least two years. CD4 cell count, used to measure the strength of the immune system, was monitored at 1-year, 2-years, and 3-years following the initiation of therapy.
The researchers could not find any increased risk of the development of AIDS, death, or CD4 cell count decline among those with both HIV and hepatitis C infection, compared with those with HIV alone, according to the study.
"Our findings highlight the importance of delivering effective HIV care to patients with hepatitis C," said Sulkowski.
Other authors of the study are Richard Moore, M.D., Shruti Mehta, Ph.D., M.P.H., and David Thomas, M.D., all from Hopkins. The study was supported by grants from the National Institute on Drug Abuse and the National Institute on Allergy and Infectious Disease.
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