Spontaneous hepatitis C virus clearance in HIV patients with chronic hepatitis C bearing IL28B-CC alleles using antiretroviral therapy

Vispo, Eugenia; Barreiro, Pablo; Plaza, Zulema; Fernández-Montero, Jose Vicente; Labarga, Pablo; de Mendoza, Carmen; Sierra-Enguita, Rocío; Treviño, Ana; Lopez, Mariola; Soriano, Vicente

AIDS:
doi: 10.1097/QAD.0000000000000275
Clinical Science
Abstract

Background: A quarter of individuals acutely infected with hepatitis C virus (HCV) clear the virus spontaneously. Once chronic infection is established, HCV elimination generally can only be achieved using specific antiviral therapy, such as peg-interferon-ribavirin. Herein, we report a group of chronically HIV/HCV-coinfected patients that cleared HCV spontaneously while being treated only with antiretrovirals.

Methods: Retrospective analysis of all HIV-infected individuals with positive HCV antibodies (HCV-Abs) and negative serum HCV-RNA seen during 2012 at a reference HIV clinic in Madrid.

Results: From a total of 2366 HIV-infected individuals, 618 (26%) were HCV-Ab+, of whom 387 (62%) were positive for serum HCV-RNA. Individuals HCV-Ab+/HCV-RNA-negative were grouped into two categories – those that had eliminated HCV following a course of antiviral treatment (n = 198, 86%) and those who had cleared the virus spontaneously (n = 33, 14%). Eight with spontaneous clearance were HBsAg+ and might have cleared HCV as a result of viral interference. However, six (24%) out of the remaining 25 did so after being serum HCV-RNA+ for longer than 6 months (median 5.6 years, range 1.3–12 years). All harbored alleles and had undetectable plasma HIV-RNA on HAART around the time of HCV clearance.

Conclusion: Spontaneous HCV clearance may occur in a subset of chronically HIV/HCV-coinfected patients on HAART harboring IL28B-CC. Given that antiretrovirals do not display any direct anti-HCV activity, recovery of innate immune responses could be responsible for these late HCV clearance episodes. Thus, periodic testing of serum HCV-RNA may be warranted in chronically HIV/HCV-coinfected patients on HAART harboring IL28B-CC alleles.

Author Information

Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.

Correspondence to Dr Vincent Soriano, Department of Infectious Diseases, Hospital Carlos III. Calle Sinesio Delgado 10, Madrid 28029, Spain. Tel: +34 91 453 2500; fax: +34 91 733 6614; e-mail: vsoriano@dragonet.es

Received 21 September, 2013

Revised 4 January, 2014

Accepted 24 February, 2014

© 2014 Lippincott Williams & Wilkins, Inc.