Current treatment of hepatitis C in HIV co- infected patients Dominique SALMON Dominique SALMON Internal Medicine Department, COCHIN Hospital Internal Medicine Department, COCHIN Hospital Paris, FRANCE Paris, FRANCE 12th ISVHLD - ANRS Co-infection day, July 5, 2006 12th ISVHLD - ANRS Co-infection day, July 5, 2006
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Current treatment of hepatitis C in HIV co-infected patients Dominique SALMON Internal Medicine Department, COCHIN Hospital Paris, FRANCE 12th ISVHLD -
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Current treatment of hepatitis C in HIV co-infected patients
Current treatment of hepatitis C in HIV co-infected patients
Dominique SALMONDominique SALMON
Internal Medicine Department, COCHIN HospitalInternal Medicine Department, COCHIN Hospital
Paris, FRANCEParis, FRANCE
12th ISVHLD - ANRS Co-infection day, July 5, 200612th ISVHLD - ANRS Co-infection day, July 5, 2006
Main points
Chronic HCV infection Candidates Pre therapeutic assessementPeg IFN and RBV dosesTreatment durationManagement of adverse events
Acute HCV infection
Candidates and Pretherapeutic assessement
Candidates to therapy
• All HCV chronically infected patients should be offered treatment if the benefits outweigh the risks
• CD4 < 200/mm3 : treat HIV first
• Alcoholics : - same efficacy of PegIFN + RBV - Pb of adherence to treatment
• Active drug users: - opiate substitution priority - case by case evaluation
Alberti et al, 1st ECC, J Hepatol 2005Alberti et al, 1st ECC, J Hepatol 2005
Pretherapeutic liver evaluation
• HCV genotype
• HCV viral load
• Liver biopsy: useful, but not mandatory when a decision to treat has been taken
• New markers of fibrosis
Impact of genotype and HCV-RNA on SVR
% pts with SVR in APRICOT
Torriani et al NEJM 2004,
0
10
20
30
40
50
60
70
geno 1 geno 2-3
> 5,9 logUI/ml
< 5,9 logUI/ml
Liver biopsy in HIV/HCV co-infected patients
Genotype 1 and 4, and high
HCV load (>800,000 IU/ml)
Presence of co-morbidities :
- Excessive alcohol
consumption
- HBV and/or delta co-infection
- Medication hepatotoxicity
Genotype 2 and 3
Genotype 1 and 4 , and
low HCV load (≤800,000
IU/ml)
Required for treatment decision
Not required for treatment decision
Alberti et al, 1st ECC, J Hepatol 2005Alberti et al, 1st ECC, J Hepatol 2005
New tests of fibrosis
FibroScan + seric markers
Discordance Concordance
Liver biopsy
Treatment or
follow-up
Follow-up
Minimal fibrosis < F2
Moderate or severe
fibrosis F >2
Treatment
Castera et al. Gastroenterology 2005; 128: 343-50.