Cincy Science: University of Cincinnati research could change how HIV-infected patients are treated

HIV patients with hepatitis C are affected

CINCINNATI -- A recent study conducted in part by the University of Cincinnati may radically change treatment for people who are infected with both HIV and hepatitis C.

The new findings contradict earlier beliefs that continuing to use HIV drug therapy in those also infected with  hepatitis C harmed liver function. About 25 to 30 percent of those infected with HIV, the AIDS virus, also carry the hepatitis C virus, making the new study important to the treatment of a wide swath of HIV-infected patients.

“Effective HIV treatment is the first, most important step a patient could take to prevent long-term liver injury,” said Dr. Kenneth Sherman, lead researcher and director of UC's Division of Digestive Diseases. “In western countries, liver disease due to hepatitis C is the leading cause of death in patients with HIV. Most people don’t realize liver disease is actually the big issue.”

Over two years, the study followed 17 patients infected with both viruses, as researchers collected blood samples, took liver biopsies and measured results. During the initial 16 weeks, the team observed a flare in hepatitis C activity among participants, possibly indicating liver damage. In the past, Sherman said physicians would have immediately stopped HIV therapy to allow the liver to recover. During the study, they continued to administer HIV drug therapy while monitoring liver function.

“Because we used to think that increases in liver enzymes and HCV were harmful to co-infected patients starting HIV treatment, many providers caring for those with HIV got nervous which led to early discontinuation of lifesaving HIV treatment,” said Dr. Richard Sterling of Virginia Commonwealth University, cosponsor of the study. “This carefully done study tells us that these transient changes are not harmful and provide reassuring data to both patients and providers.”

During a period of 18 months, the hepatitis C infection in participants decreased dramatically as the HIV infection improved, Sherman said, comparable to individuals who only carry the single hepatitis C virus. He explained the lowered viral levels then allow doctors to treat hepatitis C using new medication with the ability to actually cure it.

“There are treatments for hepatitis C and they are quite expensive, but cost-effective analysis suggests that as expensive as they are, in the long run they are much cheaper than letting patients progress to advanced liver disease,” he said.

The treatment for hepatitis C cures the virus in 90 to 100 percent of patients, Sherman said. Sherman said too much emphasis is placed on the $1,000 a day cost of the treatment and not the long-term outlook. He said the cost for liver transplants due to complications of hepatitis C can cost more than $350,000 with an ongoing cost of approximately $30,000 per year.

“Hepatitis C is a curable disease and potentially can be eradicated from the U.S. and the world just like we largely eradicated polio and smallpox,” he said. 

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