HCV Eradication in HIV/HCV-Coinfection Decreases Immune Activation

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These results support treating HCV in all patients with HIV/HCV coinfection, even patients with low-grade fibrosis.
These results support treating HCV in all patients with HIV/HCV coinfection, even patients with low-grade fibrosis.

For patients with HIV/hepatitis C virus (HCV) coinfection, eradicating HCV decreases levels of immune activation markers, proviral HIV DNA load, microbial translocation markers, and D-dimers, according to results published in the Journal of Infectious Diseases.

These results support treating HCV in all patients with HIV/HCV coinfection, even patients with low-grade fibrosis.

The study included participants with HIV/HCV coinfection who received antiretroviral treatment and achieved a sustained virologic response with interferon-free regimens (n=97).

The researchers assessed expression of HLA-DR/CD38, PD-1, and CD57 on CD4+ and CD8+ T-cells; measurement of the total HIV DNA load in peripheral blood mononuclear cells; and determination of plasma levels of soluble CD14, lipopolysaccharide, 16S ribosomal DNA, interleukin-6, D-dimers, and high-sensitivity C-reactive protein before therapy, immediately at the end of therapy, and 1 month after the end of therapy.

At the end of therapy and after 1 month of follow-up, participants had significant reductions in levels of proviral HIV DNA, soluble CD14, lipopolysaccharide, 16S ribosomal DNA, and D-dimer as well as reductions in the expression of HLA-DR and CD38 in CD4+ and CD8+ T cells (P <.001).

Participants did not show any change in the expression of PD-1 and CD57 in CD4+ and CD8+ T cells or levels of interleukin-6 and high-sensitivity C-reactive protein.

The researchers found that the participants' improvement in levels of immune activation markers, proviral HIV DNA, and microbial translocation markers did not increase CD4+ T-cell count or increase the ratio of the CD4+ T-cell count to the CD8+ T-cell count.

“In HIV/HCV- coinfected patients, HCV eradication has proven to be beneficial not only in terms of the liver-related mortality rate and fibrosis regression, but also with regard to decreases in the frequencies of HIV disease progression, non-AIDS-related events, and non-liver-related mortality,” the researchers wrote.

Reference

Lópéz-Cortés LF, Trujillo-Rodríguez M, Báaez-Palomo A, et al. Eradication of hepatitis C virus (HCV) reduces immune activation, microbial translocation, and the HIV DNA level in HIV/HCV-coinfected patients. J Infect Dis. 2018;218:624-632.

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