JOURNAL OF CLINICAL VIROLOGY
doi:10.1016/j.jcv.2010.07.006
© 2010 Elsevier B.V. All rights reserved.
B.A. Payer, T. Reiberger, K. Rutter, S. Beinhardt, A.F. Staettermayer, M. Peck-Radosavljevic, P. Ferenci
Received 12 May 2010; received in revised form 1 July 2010; accepted 6 July 2010. published online 16 August 2010.
Corrected Proof
Abstract
Introduction
The efficacy of antiviral therapy with pegylated interferon (PEGIFN) plus ribavirin (RBV) in patients with HIV and hepatitis C virus (HCV) coinfection is limited. Intravenous silibinin (ivSIL), a milk thistle extract with proven antiviral effects represents a novel therapeutic strategy for virological nonresponders.
Methods
We report a case of an HIV–HCV coinfected patient, who has not responded to a prior course of PEGIFN-α2a (180μg/week/s.c.) and RBV (1000mg/day/p.o.). Testing for IL-28β small nucleotid polymorphism revealed the nonfavourable genotype T/T. Antiretroviral therapy was not prescribed because the patients presented with well-preserved CD4+ cell counts and low HIV-RNA levels. She received retreatment with ivSIL for two weeks followed by PEGIFN/RBV combination therapy starting at week 1.
Results
After 2 weeks of ivSIL therapy both HCV-RNA and HIV-RNA become undetectable. On ivSIL monotherapy we noticed a trend towards an increase of CD4+ cell counts and a decrease of HIV-RNA. After 16 weeks PEGIFN+RBV was discontinued due to patients wish because of adverse events. HCV-RNA was still negative 24 weeks after cessation of therapy, while HIV-RNA returned to baseline levels.
Conclusion
ivSIL may represent a potential treatment option for retreatment of HIV–HCV coinfected patients nonresponding to PEGIFN+RBV combination therapy. Further investigations on the possible beneficial effects of ivSIL on CD4+ cell counts and HIV-RNA levels are necessary.
Keywords: HCV, HIV, Silibinin, Pegylated interferon, Ribavirin, Nonresponse
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