Patients With Haemophilia Co-Infected With HCV/HIV Derive Liver Benefits From HAART: Presented at Haemophilia 2010

By Thomas R. Collins

BUENOS AIRES -- July 13, 2010 -- Patients with haemophilia who are co-infected with hepatitis C virus (HCV) and HIV have a higher incidence of serious liver problems, but treatment with highly-active antiretroviral therapy (HAART) can reduce the risk associated with HCV, according to an analysis presented here at the Hemophilia World Congress 2010.

"It is well established that patients who are co-infected with HIV have a faster progression to end-stage liver disease and hepatocellular carcinoma," said Olga Katsarou, MD, National Reference Center for Bleeding Disorders, Athens, Greece, on July 12. "The introduction of highly active antiviral treatment in 1996 has dramatically modified the natural history of HIV infection by reducing the morbidity of AIDS-related causes and increasing the overall survival."

But the impact of HAART in the progression of hepatitis C remains controversial and unclear, she added, although there have been signs of a beneficial effect.

A total of 324 patients were enrolled in the study, with 164 having HCV alone and 160 infected with both HCV and HIV.

Seventy-seven patients received HCV treatment -- 57 in the HCV group and 20 in the HCV/HIV group. Sixty-five of the patients in the HCV/HIV group received HAART treatment of at least 3 months.

A total of 34 patients suffered serious liver-related events -- 12 in the HCV group and 22 in the HCV/HIV group.

Those with HCV and HIV were found to have a nearly 10-fold chance of having a serious liver-related event (hazard ratio [HR] = 9.6) compared with those with only HCV (HR = 1; P < .001).

But the chances that those with both viruses who received treatment with HAART would have a serious liver-related event were 5 times lower than the HCV/HIV group overall (HR = 1.7).

Those receiving HCV treatment had a nearly 40% reduction in risk of such an event (HR = .62), compared with the HCV-alone group, but this finding was not statistically significant.

"In our study, we found that the cumulative incidence of the development of a serious liver-related event in HCV-infected patients is higher when they are infected with HCV," Dr. Katsarou said. "The concerns that we had at the beginning that HAART could have a negative impact due to liver toxicity, it seems, to the contrary, that it can reduce the risk for the progression to end-stage liver disease in HIV co-infected haemophiliacs."

[Presentation title: Incidence of Liver-Related Morbidity in a Cohort of Haemophilia Patients: The Impact of HAART on HCV Progression. Abstract 16FP04]

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