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HCV-HIV International Panel releases new management guidelines
  By Karla Gale
NEW YORK (Reuters Health) - The HCV-HIV International Panel has just published a new consensus statement addressing management of patients co-infected with HIV and hepatitis C (HCV).
Liver disease caused by chronic HCV infection is a leading cause of death among HIV-infected patients with access to highly active antiretroviral therapy (HAART), notes the group, led by Dr. Vincent Soriano, in the January 2nd issue of AIDS. They reviewed published literature to address "the most relevant and currently conflicting topics in the management" of HCV-HIV dual infection.
Dr. Soriano, at Instituto de Salud Carlos III in Madrid, and colleagues recommend that all HIV-infected individuals be screened for HCV antibodies. They suggest that anti-HCV treatment be initiated for those positive for HCV RNA who has repeated liver enzyme abnormalities, CD4 counts greater than 350 cells per microliter, and relatively low HIV viremia. Interferon is contraindicated in those with previous severe neuropsychiatric conditions.
If serum HCV-RNA levels do not drop more than 2 logs at 12 weeks, the clinician should consider discontinuing therapy, according to the report.
"But you have to put this in clinical perspective," co-author Dr. Douglas Dieterich told Reuters Health. "The standard error of the test is about 1 log. So even if there is only a 1.5 log decrease but the patient is tolerating the drugs, you should certainly keep going."
There is concern that hepatotoxic drugs could increase liver enzyme levels, so the authors advise that drugs such as nevirapine and ritonavir be used cautiously.
"Didanosine is a definite no-no; it is absolutely contraindicated in patients being treated with ribavirin," added Dr. Dieterich, who is based at Mount Sinai Medical Center in New York.
The panel advises physicians to learn how to best manage side effects of drug treatment, such as influenza-like symptoms, neutropenia, and anemia. Treatment for depression is warranted if symptoms begin to develop.
Liver transplantation is appropriate for some patients with end-stage liver disease due to HCV, the authors note. Contraindications are advanced HIV disease, severe immunodeficiency, or current alcohol or illegal drug use. Drug treatment should also be delayed until active illegal drug or excessive alcohol intake has stopped.
"At the Retrovirus meeting coming up in February, all three of the very large HIV-HCV co-infection trial results will be presented," Dr. Dieterich said. "Some of the news presented will be very encouraging for hepatitis C treatment."
AIDS 2004;18:1-12.


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