Kinetic study of hepatitis c viremia in patients coinfected with human immunodeficiency virus receiving antiretroviral therapy

KINETIC STUDY OF HEPATITIS C VIREMIA IN PATIENTS COINFECTED WITH HUMAN IMMUNODEFICIENCY VIRUS RECEIVING ANTIRETROVIRAL THERAPY D. Vitour l, C. Payan 1, P. Fialaire 2, J.M. Cbennebault 2, J. Loison 2, E. Pichard 2, E Lunel l tLaboratoire de Virologic, CHU Angers, France. 2Service des Maladies Infectieuses, CHU Angers, France. In this study, we assessed, during two years, the effect of highly active antiretroviral therapy (HAART) including at least one protease inhibitor (PI) on hepatitis C (HCV) viremi~ Several studies but one showed that HCV replication was not modified under HAART. Late HCV viral load measurement may be responsible for these results. Methods: Eleven HCV and I-HV coinfected patients and treated from 1996 to 1999 with HAARTPI were included in this study. Quantification of H/V RNA (Nuclisens HIV test, Organon Teknika, lowest cut-off at 1.6 LOg/mL) and HCV RNA (branched DNA, Quantiplex 2.0, Bayer-Chiron, cut-off level at 5.2 Log eq/mL) were performed on EDTA plasma samples before treatment and at month (M) 1, 3, and every other three months up to M24. CD4 and CD8 cell counts and alanine aminotransferase (ALT) activity were assessed monthly. HCV RNA detection was assessed using the COBAS Amplicor HCV RNA 1.2 kit (Roche Diagnostics; cut-off level at about 3 Log RNA copies/mL), and using an in-house nested RT-PCR method (cut-off level at about 2 Log RNA cupies/mL). Results: A transient elevation of HCV RNA level (+0.8 Log eq/mL) was observed in nine patients within two months followin~ HAART initiation with fast decrease to baseline (7.2-*0.5 Log) after few weeks up to M24. Two patients showed under ritonavir or indinavir a substantial reduction ofHCV RNA viremia during this period. HCV RNA became undetectable usin~ RT-PCR between M6 and M9 up to M24. Canclmian: No specific profile was found in the two patients concerning HCV viral load, HCV genotype, immune status at baseline, and type of protease inhibitors. However, a very high increase of ALT values was observed around M6 and was associated with HCV fall and with CD4 and CD8 cell increases suggesting immune restoration. Specific humeral and cytokine response as well as viral quasispecies characterisation are under study in our laboratory. C05/11 ]