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Hep C tx and HIV coinfection
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Hep C tx and HIV coinfection

Hi,
I'm expecting to begin tx in about a month. I'm stage 3/6, genotype 1a, vl around 1.5 million. I'm also HIV positive which is under control with meds (CD4 550-600, vl 101). I know this somewhat reduces my odds for achieving SVR, can anyone tell me whether coinfection is likely to have any effect on the severity of the side effects? I know I'll be taking 180 mg Pegasys, I don't know how much riba I'll be getting yet. From reading some of the posts regarding side effects, I have already received some valuable information from those of you who are going/have gone through this before me. Thanks.
Tags: hep c tx, HIV
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1815939_tn?1377995399
I found an article on treatment of Hep C coinfection with HIV. It is new (2012) and is from AIDS info NIH. The article seems to indicate that the use of protease inhibitors in conjunction with Interferon and Ribavirin can be considered and done. If you cannot do triple medication treatment through your doctor, perhaps you can get into treatment at a large university affiliated medical center. Or, perhaps you can get into a study. It seems that treatment with the tyriple medication regimen has much better SVR rates.

In part:
"A combination regimen of peginterferon and ribavirin (PegIFN/RBV) has been the mainstay of treatment for HCV infection. In HCV genotype 1-infected patients without HIV, addition of an HCV NS3/4A protease inhibitor (PI) boceprevir or telaprevir to PegIFN/RBV significantly improves the rate of sustained virologic response (SVR) [14, 15]. Clinical trials of these HCV PIs in combination with PegIFN/RBV for the treatment of HCV genotype 1 infection in HIV-infected patients are currently under way."

"Following are preliminary recommendations for the use of boceprevir or telaprevir in HIV patients coinfected with HCV genotype 1 based on current ART use. These recommendations may be modified as new drug interaction and clinical trial information become available.

Patients not on ART:   Use either boceprevir or telaprevir
Patients receiving RAL + 2-NRTI: Use either boceprevir or telaprevir
Patients receiving ATV/r + 2-NRTI: Use telaprevir at standard dose. Do not use boceprevir.
Patients receiving EFV + 2-NRTI: Use telaprevir at increased dose of 1125 mg every 7–9 hours. Do not use boceprevir.

Patients receiving other ARV regimens:

    If HCV disease is minimal (i.e., no or mild portal fibrosis), consider deferring HCV treatment given rapidly evolving HCV drug development.
    If good prognostic factors for HCV treatment response are present—IL28B CC genotype or low HCV RNA level (<400,000 International Unit [IU]/mL)—consider use of PegIFN/RBV without HCV NS3/4A PI.
    On the basis of ART history and HIV genotype testing results, if possible, consider switching to the ART regimens listed above to permit the use of boceprevir or telaprevir.
    For patients with complex ART history or resistance to multiple classes of ART, consultation with experts regarding the optimal strategy to minimize the risk of HIV breakthrough may be needed. In such patients, telaprevir may be the preferred HCV NS3/4A PI because its duration of use (12 weeks) is shorter than that of boceprevir (24 to 44 weeks).

Summary:
In summary, HCV coinfection and use of PegIFN/RBV with or without HCV NS3/4A PIs (telaprevir or boceprevir) to treat HCV may impact the treatment of HIV because of increased pill burden, toxicities, and drug-drug interactions. Because ART may slow the progression of HCV-related liver disease, ART should be considered for most HIV/HCV-coinfected patients, regardless of CD4 count. If treatment with PegIFN/RBV alone or in combination with one of the HCV NS3/4A PIs (telaprevir or boceprevir) is initiated, the ART regimen may need to be modified to reduce the potential for drug-drug interactions and/or drug toxicities that may develop during the period of concurrent HIV and HCV treatment. The science of HCV drug development is evolving rapidly. As new clinical trial data on the management of HIV/HCV-coinfected patients with newer HCV drugs become available, the Panel will modify its recommendations accordingly."

http://www.aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-treatment-guidelines/26/hepatitis-c--hcv--hiv-coinfection
5 Comments Post a Comment
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163305_tn?1333672171
Riba dosage is usually weight based.
Although I can't help you with anything about co-infection, I can suggest a really good web site for information.
Good luck.

http://www.hivandhepatitis.com
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766573_tn?1365170066
Greetings and welcome to the forum! Are you going to treat with one of the protease inhibitors Incivek (telaprevir) and Victrelis (boceprevir)? If so the side effect profile is very different. Indeed the whole treatment experience is different. I have not read many posts on here related to HIV co-infection.

There is a blog I gloss over every now and then on The Body web site and it is the only exposure I have had to the sides of HCV meds for folks with HIV. From what I have gathered you run the risk for the same sides we do with the PI's however because I do not know much about HIV meds (to me) it looks like the potential for drug interactions may be different:

http://www.thebody.com/content/66483/more-news-on-drug-interactions-with-new-hcv-drugs.html

http://www.thebody.com/content/65953/making-sense-of-the-drug-interaction-warning-for-h.html

Her whole blog is insightful though it does not take the place of personal experience. I hope someone else posts soon
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Avatar_m_tn
Thank you for your reply. My doctor tells me the new regimen is not yet approved for HCV/HIV coinfected patients. He also doesn't feel it wise to wait for approval before starting tx. So, I'm only going to be taking Pegasys, riba, and my HIV meds which were chosen with eventual HCV tx in mind--there should be no interactions there.
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Avatar_m_tn
Thank you. There is a lot of interesting information there. I was also able to look at results of the clinical trials of the new triple therapy in HCV/HIV coinfected patients. They appear very encouraging. If I don't reach SVR the first time out, hopefully it will slow progression down enough so I can try again with the triple therapy once it's approved for me.
Blank
1815939_tn?1377995399
I found an article on treatment of Hep C coinfection with HIV. It is new (2012) and is from AIDS info NIH. The article seems to indicate that the use of protease inhibitors in conjunction with Interferon and Ribavirin can be considered and done. If you cannot do triple medication treatment through your doctor, perhaps you can get into treatment at a large university affiliated medical center. Or, perhaps you can get into a study. It seems that treatment with the tyriple medication regimen has much better SVR rates.

In part:
"A combination regimen of peginterferon and ribavirin (PegIFN/RBV) has been the mainstay of treatment for HCV infection. In HCV genotype 1-infected patients without HIV, addition of an HCV NS3/4A protease inhibitor (PI) boceprevir or telaprevir to PegIFN/RBV significantly improves the rate of sustained virologic response (SVR) [14, 15]. Clinical trials of these HCV PIs in combination with PegIFN/RBV for the treatment of HCV genotype 1 infection in HIV-infected patients are currently under way."

"Following are preliminary recommendations for the use of boceprevir or telaprevir in HIV patients coinfected with HCV genotype 1 based on current ART use. These recommendations may be modified as new drug interaction and clinical trial information become available.

Patients not on ART:   Use either boceprevir or telaprevir
Patients receiving RAL + 2-NRTI: Use either boceprevir or telaprevir
Patients receiving ATV/r + 2-NRTI: Use telaprevir at standard dose. Do not use boceprevir.
Patients receiving EFV + 2-NRTI: Use telaprevir at increased dose of 1125 mg every 7–9 hours. Do not use boceprevir.

Patients receiving other ARV regimens:

    If HCV disease is minimal (i.e., no or mild portal fibrosis), consider deferring HCV treatment given rapidly evolving HCV drug development.
    If good prognostic factors for HCV treatment response are present—IL28B CC genotype or low HCV RNA level (<400,000 International Unit [IU]/mL)—consider use of PegIFN/RBV without HCV NS3/4A PI.
    On the basis of ART history and HIV genotype testing results, if possible, consider switching to the ART regimens listed above to permit the use of boceprevir or telaprevir.
    For patients with complex ART history or resistance to multiple classes of ART, consultation with experts regarding the optimal strategy to minimize the risk of HIV breakthrough may be needed. In such patients, telaprevir may be the preferred HCV NS3/4A PI because its duration of use (12 weeks) is shorter than that of boceprevir (24 to 44 weeks).

Summary:
In summary, HCV coinfection and use of PegIFN/RBV with or without HCV NS3/4A PIs (telaprevir or boceprevir) to treat HCV may impact the treatment of HIV because of increased pill burden, toxicities, and drug-drug interactions. Because ART may slow the progression of HCV-related liver disease, ART should be considered for most HIV/HCV-coinfected patients, regardless of CD4 count. If treatment with PegIFN/RBV alone or in combination with one of the HCV NS3/4A PIs (telaprevir or boceprevir) is initiated, the ART regimen may need to be modified to reduce the potential for drug-drug interactions and/or drug toxicities that may develop during the period of concurrent HIV and HCV treatment. The science of HCV drug development is evolving rapidly. As new clinical trial data on the management of HIV/HCV-coinfected patients with newer HCV drugs become available, the Panel will modify its recommendations accordingly."

http://www.aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-treatment-guidelines/26/hepatitis-c--hcv--hiv-coinfection
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