Researchers disprove long-standing belief about HIV treatment

July 25, 2008

Researchers at Wake Forest University Baptist Medical Center have disproved a long-standing clinical belief that the hepatitis C virus slows or stunts the immune system's ability to restore itself after HIV patients are treated with a combination of drugs known as the "cocktail."

Hepatitis C (HCV) infection is more serious in HIV-infected people, leading to rapid liver damage, according to the Centers for Disease Control. Intravenous drug use is a main method of contraction for both HIV and HCV and 50 to 90 percent of HIV-infected drug users are also infected with HCV.

The Wake Forest Baptist study looked at whether having HCV co-infection impairs immune restoration in patients receiving highly active anti-retroviral therapy (HAART) to suppress their HIV infection. The results appear in the July issue of AIDS Research and Human Retroviruses.

The research focused on levels of CD4 cells, the specific type of immune cell that is attacked by the HIV virus, and their ability to rebuild after HIV is suppressed.

"We've been observing that in some patients that are co-infected with hepatitis C, we were treating their HIV with HAART but didn't always get very good restoration of CD4," said Marina Nunez, M.D., lead researcher and an assistant professor of infectious diseases. "Some studies suggested it was because of the hepatitis C. This study says it's not the presence of active hepatitis C replication."

Thus, said Nunez, genetic factors involved in the immune system regulation, confounding factors associated with HCV acquisition, or other unknown factors might explain the blunted immune restoration observed in some co-infected patients. "Research efforts should pursue the role of those other factors in the immune restoration," she said.

"From a clinical standpoint, although these findings will not alter the clinical management of HIV-HCV-co-infected patients, they make clear that even after successful treatment of the HCV infection, some patients may still not get an adequate CD4 recovery under HIV treatment."

For the retrospective study, researchers examined existing medical records of 322 patients from two separate databases – one from Madrid, Spain, and the other from Wake Forest University Baptist Medical Center. Patients were separated into two groups – those co-infected with hepatitis C and HIV and those infected only with HIV. Researchers reviewed CD4 levels at baseline (before beginning HIV suppression) and every year after for up to three years, while the patients continuously received HAART, an HIV treatment consisting of three different types of medicines used by many patients, and formerly referred to as the HIV "cocktail."

Years of clinical experience have shown that, with HAART treatment suppressing the HIV, CD4 levels are typically able to restore themselves, Nunez said.

However, in some patients, it has been observed that the immune restoration is poorer after HAART. Therefore, Nunez said, it has been a common practice for doctors to attribute less than desirable CD4 restoration after HAART in co-infected patients to the hepatitis C virus.

Studies to date have found evidence both in support of and against this belief, Nunez said. But a limitation in previous studies has been that co-infected patients have been identified by the presence of HIV and the hepatitis C antibody. Since many patients with hepatitis C clear 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 cell replication, therefore active virus, were classified as "co-infected."

The study found that there is no difference in the CD4 restoration of co-infected patients and mono-infected patients. However, it did show some differences that seem to be associated with age, gender or past intravenous drug use.

"The purpose of this study was to find out if hepatitis C was impeding the CD4 restoration in co-infected patients," Nunez said. "And it does not. There are other factors doing it. This study says that you can look into those other factors, but we cannot blame the hepatitis C anymore."

Source: Wake Forest University

Explore further: Gene transcription in virus-specific CD8 T cells differentiates chronic from resolving HCV

Related Stories

Gene transcription in virus-specific CD8 T cells differentiates chronic from resolving HCV

October 17, 2017
Massachusetts General Hospital (MGH) investigators have identified differences in gene transcription within key immune cells that may distinguish those individuals infected with the hepatitis C virus (HCV) who develop chronic ...

Opioid epidemic causing rise in hepatitis C infections and other serious illnesses

September 26, 2017
Many Americans now know that, over the past decade, opioid addiction and deaths from opioid overdose in the U.S. have skyrocketed.

Three or more cups of coffee daily halves mortality risk in patients with both HIV and HCV

September 25, 2017
Patients infected by both human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are at specific risk of end-stage liver disease and greater risk of cardiovascular diseases and cancer. In addition, HIV infection accelerates ...

'Increased risk' donor organs a tough sell to transplant patients

October 5, 2017
Increasingly, transplant surgeons must initiate a tough conversation: explaining to patients what it means to accept an organ from a person who died from a drug overdose.

Rapid hepatitis C testing may help better screen young adults

September 21, 2017
Routine and rapid hepatitis C virus (HCV) testing among young adults who use injection drugs improves life expectancy and may provide a good use of limited resources, according to new research out of Boston Medical Center, ...

Study questions practice of placenta eating by new moms

September 29, 2017
(HealthDay)—You may have heard that some new mothers choose to eat their own placenta after childbirth. But there's no indication the trendy practice offers any health benefits, and some evidence it could prove dangerous, ...

Recommended for you

Scientists find where HIV 'hides' to evade detection by the immune system

October 19, 2017
In a decades-long game of hide and seek, scientists from Sydney's Westmead Institute for Medical Research have confirmed for the very first time the specific immune memory T-cells where infectious HIV 'hides' in the human ...

National roll-out of PrEP HIV prevention drug would be cost-effective

October 18, 2017
Providing pre-exposure prophylaxis (PrEP) medication to men who have sex with men who are at high risk of HIV infection (equivalent to less than 5% of men who have sex with men at any point in time) in England would be cost-effective, ...

Regulatory T cells harbor HIV/SIV virus during antiviral drug treatment

October 17, 2017
Scientists at Yerkes National Primate Research Center, Emory University have identified an additional part of the HIV reservoir, immune cells that survive and harbor the virus despite long-term treatment with antiviral drugs.

New research opens the door to 'functional cure' for HIV

October 17, 2017
In findings that open the door to a completely different approach to curing HIV infections, scientists from the Florida campus of The Scripps Research Institute (TSRI) have for the first time shown that a novel compound effectively ...

Researchers create molecule that could 'kick and kill' HIV

October 5, 2017
Current anti-AIDS drugs are highly effective at making HIV undetectable and allowing people with the virus to live longer, healthier lives. The treatments, a class of medications called antiretroviral therapy, also greatly ...

A sixth of new HIV patients in Europe 50 or older: study

September 27, 2017
People aged 50 and older comprise a growing percentage of HIV patients in Europe, accounting for one in six new cases in 2015, researchers said Wednesday.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.