Massive Change in U.S. Treatment Guidelines
Long-term studies have found that about 33% of people with HCV mono-infection develop severe liver damage in about 20 years after infection. However, the following factors can accelerate the course of liver disease:
Analysis of several studies in people co-infected with HCV and HIV suggest that the speed at which severe liver damage occurs is about three times greater in cases of co-infection, particularly when CD4+ counts are low.
Before beginning HIV therapy, the panel encourages doctors to test their HIV-positive patients for HCV infection.
Here are some critical points about care that the panel mentions:
HIV treatment considerations for people with HCV co-infection:
Exposure to anti-HIV drugs may cause liver injury, particularly in people co-infected with HCV and HIV. The greatest risk for this toxicity occurs in people with severe liver damage, cirrhosis or end-stage liver disease. Successful treatment of HCV infection may decrease the chance of liver injury caused by anti-HIV therapy.
Starting Anti-HIV Therapy
The panel recommends that co-infected people begin therapy once CD4+ counts fall below the 500-cell mark. It recommends the same combinations for co-infected people as for HIV-mono-infected people.
Anti-HIV Drugs to Avoid
The panel recommends that patients considering or receiving ribavirin should avoid the use of these anti-HIV drugs:
This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication TreatmentUpdate. Visit CATIE's Web site to find out more about their activities, publications and services.