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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

doi: 10.1097/QAD.0000000000000275
Clinical Science

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.

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.