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Study: Hepatitis C does not impede HIV treatment
It shows other factors are to blame for blocking recovery of immune system
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Published: July 25, 2008
A study on hepatitis C done by researchers at Wake Forest University Baptist Medical Center is adding to the debate about whether the virus stunts or slows the recovery of the immune system in HIV patients treated with a drug "cocktail."
The study, which will be released today, appears in the July issue of AIDS Research and Human Retroviruses.
At least 5 million people worldwide are infected with HIV or AIDS and hepatitis C, including more than 300,000 in the United States, according to a 2004 international study.
Hepatitis C -- a liver disease spread through contact with infected blood, primarily through the sharing of contaminated needles -- can be a serious health issue for people with an HIV infection.
A 2006 report from the medical school at Brown University showed that people infected with both diseases "may develop cirrhosis and end-stage liver disease more quickly than individuals infected with only hepatitis C."
The Baptist researchers said their study of 322 patients, including 186 from the Triad and North Carolina, "disproves a long-standing clinical belief" that hepatitis C affects the recovery of the immune system in patients receiving a cocktail of highly active anti-retroviral therapy to suppress their HIV infection.
"The purpose of this study was to find out if hepatitis C was impeding the CD4 restoration in co-infected patients, and it does not," said Dr. Marina Nunez, the lead researcher and an assistant professor of infectious diseases at Baptist.
CD4 cells are the specific type of immune cell that is attacked by the HIV virus. The research focused on the CD4 cells' ability to rebuild after HIV is suppressed.
Nunez said that other factors could be impeding the CD4 cell recovery, including genetics, age, and drug and alcohol use.
"This study says that you can look into those other factors, but we cannot blame the hepatitis C anymore," she said.
There has been considerable debate on the impact hepatitis C has on the immune systems of people infected with HIV, said Dr. Mark Sulkowski, an associate professor of medicine in the infectious-disease division at Johns Hopkins University School of Medicine.
"Some studies confirm the role and others, like this study, don't confirm it or downplay its importance," Sulkowski said.
"This report will contribute to the argument for no major impact."
The Centers for Disease Control and Prevention said that intravenous drug use is a primary method of contraction of both HIV and hepatitis C. Between 50 percent and 90 percent of HIV-infected drug users also are infected with hepatitis C.
The Brown report said that "barriers to treating hepatitis C in co-infected individuals are plentiful and have been identified in recent studies."
Complicating matters is that many people with hepatitis C don't have any symptoms of the disease.
"It is important for HIV-infected persons to know whether they are also infected with Hepatitis C and, if they aren't, to take steps to prevent infection," according to the federal agency.
The Baptist study examined medical records of 322 patients from Madrid, Spain, and at Baptist.
Patients were separated into two groups -- those infected with hepatitis C and HIV, and those infected only with HIV. Researchers reviewed CD4 levels before beginning HIV suppression and every year after, for up to three years, while patients received the highly active anti-retroviral therapy.
Years of clinical experience have shown that, with highly active anti-retroviral therapy suppressing the HIV, CD4 levels are typically able to restore themselves, Nunez said.
"We've been observing that in some patients that are co-infected with hepatitis C, we were treating their HIV with highly active anti-retroviral therapy, but didn't always get very good restoration of CD4," Nunez said.
"Some studies suggested it was because of the hepatitis C," Nunez said. "This study says it's not the presence of active hepatitis C replication."
Baptist researchers said that a limitation in previous studies was that patients infected with both diseases were identified by the presence of HIV and the hepatitis C antibody.
The researchers said that since many patients with hepatitis C show no signs of the active virus, but continue to carry the antibody, there hasn't been a pure sample of patients "truly co-infected with both active viruses to analyze."
"In this study, only patients with HIV and active hepatitis C virus replication, therefore active virus, were classified as co-infected," the researchers said.
"From a clinical standpoint, although these findings will not alter the clinical management of HIV-hepatitis C co-infected patients, they make clear that even after successful treatment of the hepatitis C infection, some patients may still not get an adequate CD4 recovery under HIV treatment."
The Brown report said "an enormous need for further research remains."
"Studies are in progress to evaluate new agents, potential medications, to target the hepatitis C virus. As the population of co-infected individuals ages, there will be a greater prevalence of advanced liver disease over time."
■ Richard Craver can be reached at 727-7376 or at rcraver@wsjournal.com.
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