1. A. Stepanov, A. Kruk, N. Polovinkina, A. Vinogradova
Peoples' Friendship University of Russia, Moscow The Faculty of Medicine Chair of Infectious Diseases Chair of Internal diseases
Efficacy of a 24 week course of acute HCV treatment with peg-interferon α-2b and ribavirin in HIV-infected patients
A. Stepanov, A. Kruk, N. Polovinkina, A. Vinogradova

2. A global view of HIV infection
38.6 million people [33.4‒46.0 million] living with HIV, 2005
2.4

3. Officially Registered HIV Cases in the Russian Federation 1 January 1987 through 30 June 2006 (based on data from the Russian Federal AIDS Centre)
250.0
200.0
150.0
Prevalence, per 100,000
Registered HIV Cases
100.0
50.0
0.0
New Registered Cases
1090
1513
4315
3971
19758
59261
87671
49923
36396
34306
35526
13492
2603
6918
10889
30647
89908
177579
227502
263898
298204
333730
347222
0,7
1,4
4,2
6,7
19,8
59,5
118,9
152,7
178,4
202,8
227,4
235,4 1
2,9
2,7
13,5
40,8
60,8
34,6
25,3
23,9
24,9
9,5
Cumulative Registered Cases
Prevalence per
Annual Incidence per

4. Increase in reported HIV cases
in the Russian Federation and Ukraine,
Reported HIV cases
in the Russian Federation
Reported HIV cases
in Ukraine
30 000
45 000
60 000
75 000
90 000
15 000
Russian Federation
Newly reported cases
Cumulative (previous years)
Ukraine
Newly reported cases
Cumulative (previous years)
50 000
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
Sources: Russian Federal AIDS Centre; Ukranian AIDS Centre and Ministry of Health of Ukraine
2.12

5. HIV-infection cases reported among Russian citizens by main risk factors, 2004 (Russian Federal AIDS Centre data)
Born to infected mother (0.9%)
Blood
Transfusion
(0%)
Heterosexual
contact (30.0%)
Homosexual
contact (0.8%)
IDU (68.3%)

6. HCV and public health HCV incidence in the world: 3 % (0,1-5 %)
Chronic hepatitis C can be found in 30% of all HIV-patients
HCV/HIV coinfected patients show a faster progression to cirrhosis and increased liver-related mortality
In the developed countries, HCV is responsible for:
20 % of acute hepatites
70 % of chronic hepatites
40 % of decompensated cirrhosis
60 % of CHC cases
30 % of liver transplantations
EASL International Consensus Conference on Hepatitis C. Paris, February Consensus statement. J Hepatol ; 30 : First European Consensus Conference on the treatment of chronic hepatitis B and C in HIV-coinfected patients. J Hepatol 2005; 42:

7. Liver Disease Has Become a Major Cause of Death in the Era of Potent Antiretroviral Therapy
Mortality from end-stage liver disease (ESLD) as
a % of all mortalities among HIV patients 60
50% 50
45% 40
35%
Mortality (%) 30 20
13%
12% 10 5%
Italy (Brescia)
Spain (Madrid)
USA (Boston)
Bica Clin Infect Dis 2001;
Puoti JAIDS 2000;
Soriano Eur J Epidemiol 1999; Soriano PRN Notebook 2002;
Martin-Carbonero AIDS Res Human Retrovirus 2001
Pre-therapy era
Therapy era

8. Mortality Among HIV-Infected Patients in France (GERMIVIC Study Group)
Rosenthal E et al. For the GERMIVIC Joint Study Group, 2nd IAS Conference on HIV
Pathogenesis and Treatment, Paris 2003; 87

9. Progression to HCC in HCV/HIV-Coinfected Patients
HCV/HIV-coinfected patients progress more rapidly to HCC than HCV-monoinfected patients
Coinfected pts also younger at HCC diagnosis, have higher AFP levels, receive HCC treatment more often
HIV/HCV
(n = 41)
HCV
(n = 119)
P Value
Mean duration of HCV infection at time of HCC diagnosis, yrs
26.4
(n = 30)
35.2
(n = 62)
< .001
Mean age, yrs
52.4
61.1
Median AFP level, ng/mL
1274
192
.002
Excessive alcohol use, %
48.7
(n = 39)
71.0
(n = 100)
.005
Receive HCC therapy, % 56 36
.025
Retrospective analysis of all HCC cases in HIV/HCV coinfected patients from in 15 US and Canadian centers
Comparison with all HCV-monoinfected HCC patients diagnosed in 3 tertiary care facilities from
Bräu N, et al. IAS Abstract TuPe1.1C17.

10. Study Objectives
To assess the efficacy and tolerability of acute hepatitis C treatment with peg-interferon α-2b and ribavirin in the HCV/HIV co-infected population:
the proportion of patients with SVR;
the proportion of patients with undetectable HCV VL at the end of treatment (EOT);
changes in liver enzymes from baseline to week 48.

11. Study Design
Patients with confirmed HCV seroconversion during a period shorter than 6 months
Observation period: Follow-up for 12 weeks with monthly clinical examinations
HCV Treatment with PegInterferon α-2b
(1.5 mcg/kg/weekly) and Ribavirin (800 mg/daily) for 24 weeks
Results: weeks
24 weeks – EOT
48 weeks – SVR

12. Baseline characteristics of the patients studied
Male, n (%)
25 (79)
Median age, years (range)
29 (19-39)
Risk factors
IVDU, cessation of drug use, n (%)
Sexual exposure, n (%)
28 (88)
4 (12)
Antiretroviral therapy, n (%)
Yes No
26 (81)
6 (19)
HIV-1 RNA, cp/ml
Below 400, n (%)
CD4 cells/μl
Median (range)
413 ( )
HCV genotype, n (%)
2 or 3
1 or 4
23 (72)
9 (28)
HCV RNA, IU/ml
775300
(3.200 – 5.2x106)
ALT, IU/l
98 ( )
Clinical manifestations, n (%)
8 (25)

13. Patients with HCV-RNA negative results

14. Percentage of negative plasma HCV-RNA in patients with infection caused by genotype 1-4 and genotypes 2-3 HCV

15. Changes in aminotransferase levels during the 48 weeks of study

16. Conclusions
This study shows good efficacy of PegINFα-2b and Ribavirin combination therapy for the treatment of acute HCV in HIV-infected patients with SVR – 75%
The results of this study, if confirmed in a larger population, could justify the treatment of acute HCV in order to avoid the progression of the disease and to reduce the risk of HCV transmission

17. Acknowledgements We would like to thank
Our patients and their families
All medical and nursing staff of the hepatologic centre and the 25-th out-patient clinic who helped us to conduct this study
All staff of Chair of Infectiuos Diseases and Chair of Internal Diseases, Peoples’ Friendship University of Russia, Moscow