May 9, 2011
From a study reported in the April 24, 2011 issue of AIDS, people co-infected with HIV and hepatitis C who stop taking their HIV meds run about a 2.5 times higher risk of liver fibrosis compared to those who don't interrupt their HIV regimens. This finding echoes similar results from other studies such as SMART in HIV mono-infected individuals, which showed that interrupting HIV treatment increases the risk of certain non-AIDS conditions.
The CTN222 study followed 541 co-infected people who had stopped HIV meds for at least two weeks. Only those who had little or no fibrosis were included and followed for an average of one year. Fibrosis was measured every six months by using blood markers, called the APRI method. Significant fibrosis was considered as an APRI score of 1.5 or more. (Ultrasounds or biopsies were not done, which are considered more accurate tests for fibrosis.)
Over six years of study, a total of 53 people stopped their HIV meds for an average of 180 days. A partially different group of 53 people developed significant fibrosis. Although lower CD4 counts and detectable viral loads partly contributed to the higher risk of fibrosis, stopping HIV meds appears to independently increase the risk as well.
These results underscore the need for careful choices of appropriate HIV regimens and follow-up of a patient's health to limit treatment interruptions. They further emphasize the need for staying on an HIV regimen during HCV treatment, which can be difficult given the dearth of information from few drug interactions studies between the full range of HIV meds and the two recently approved hepatitis C drugs, Incivek (telaprevir) and Victrelis (boceprevir).
Thorpe, J; et al. Antiretroviral treatment interruption leads to progression of liver fibrosis in HIV-hepatitis C virus co-infection. April 24, 2011 issue of AIDS.