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Sustained virological response after early antiviral treatment of acute hepatitis C virus and HIV coinfection.

AbstractBACKGROUND:
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-alpha, and antiretroviral therapy was coadministered early during primary infection. HCV viremia was cleared under therapy with pegylated interferon-alpha 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/microL).
CONCLUSIONS:
Anti-HIV and -HCV therapy should be considered early in cases of concomitant acute HCV and HIV coinfection, because successful 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.
AuthorsJulian Schulze Zur Wiesch, Dorothea Pieper, Ingrid Stahmer, Thomas Eiermann, Peter Buggisch, Ansgar Lohse, Joachim Hauber, Jan van Lunzen
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America (Clin Infect Dis) Vol. 49 Issue 3 Pg. 466-72 (Aug 01 2009) ISSN: 1537-6591 [Electronic] United States
PMID19580412 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)
Chemical References
  • Anti-HIV Agents
  • Antiviral Agents
  • Interferon alpha-2
  • Interferon-alpha
  • Recombinant Proteins
Topics
  • Anti-HIV Agents (therapeutic use)
  • Antiretroviral Therapy, Highly Active
  • Antiviral Agents (therapeutic use)
  • CD4 Lymphocyte Count
  • CD4-Positive T-Lymphocytes (immunology)
  • CD8-Positive T-Lymphocytes (immunology)
  • Female
  • HIV Infections (complications, drug therapy)
  • Hepatitis C (complications, drug therapy)
  • Humans
  • Interferon alpha-2
  • Interferon-alpha (therapeutic use)
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Recombinant Proteins
  • Time Factors
  • Treatment Outcome
  • Viral Load

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