Eliminate hepatitis C virus in people with HIV

Human immunodeficiency virus (HIV) is a virus that attacks the immune system. Hepatitis C, on the other hand, is an infection caused by a virus (HCV) that damages the liver. What do they both have in common?

In Spain, it is estimated that 30% of the total number of people with HIV – between 130 000 and 160 000 – are coinfected with HCV. A fact that can be explained by the fact that both viruses have common transmission routes; In the past, HCV coinfection was common among people diagnosed with HIV, especially among injection drug users.

According to Dr. José Miguel Benito, researcher at the Institute of Medical Research of the Jiménez Díaz Foundation (IIS-FSJ/UAM) at the Rey Juan Carlos University Hospital, “In Spain, the most common mode of transmission at the beginning of the epidemic was the decades of the 80s and 90s of the last century – was parenteral to intravenous drug users, meaning that a high percentage of people infected with HIV were also infected with HCV.

In this context, and as a result of concerns about the impact that HCV infection may have on the clinical course of HIV, research is key to determining whether the dual stress of the immune system may worsen the long-term health of people with HIV. For Dr. Norma Rallon, one of the study leaders and also a researcher at IIS-FJD/UAM at the Rey Juan Carlos University Hospital, “research on the topic of HIV and HCV co-infection is very important not only because it is not only a health problem, given the high prevalence of infection HCV in the HIV population, but also because of the big challenge to the immune system of those infected with both viruses and all the consequences that entails.”

This is being done by the Infectious Diseases and Tropical Medicine research group of IIS-FJD/UAM and the Fundación Jiménez Díaz and Rey Juan Carlos (Móstoles) University Hospitals, which carried out the study. The DAA Era: Patient Assessment. Characteristics, clinical impact and occurrence of comorbidities in persons with HIV/HCV coinfection and HIV-infected persons, which was just published in Journal of Clinical Medicineto see whether treating HCV infection can change the clinical course of people infected with both HIV and HCV.

The problem of HIV/HCV co-infection

In general, co-infection with HIV and HCV complicates both diseases: the presence of both viruses in the same person leads to interaction, such that one infection can alter the clinical course of the other. In the study, researchers are analyzing the impact of hepatitis C treatment in people with HIV, particularly on morbidity and mortality rates in populations infected with the two viruses.

As emphasized by Dr. Beatriz Alvarez, the first signatory of the study, a specialist in the infectious diseases department of the Jiménez Díaz Foundation and a researcher at the Health Research Institute of the Jiménez Díaz Foundation (IIS-FJD/UAM), “people with HIV suffer from a higher incidence of various pathologies and in at an earlier age than the seronegative population due to the existence of chronic inflammation.” When you add hepatitis C virus to the mix, “this fact is compounded” because it is another virus that causes chronic infection.

The power of new direct-acting antivirals

Advances in drugs to treat the hepatitis C virus have made giant strides over the past ten years. One such advance is the new direct-acting antiviral drugs (DAAs), which have revolutionized the treatment of people with hepatitis C virus infection, a growing infection that is causing new cases every time and whose causes we must look for. look for “in intravenous drug use and sexual transmission, especially when we combine both ingredients, as occurs with the phenomenon chemsex – drug use for sexual purposes – and slamsex intravenously,” says Dr. Alvarez.

Thanks to these antiviral drugs, it is possible to act directly on viral replication, which allows for a cure close to 100%, fewer side effects and excellent tolerability in just two to three months. “This achievement has completely changed the scenario of hepatitis C, turning it into a disease that can be eradicated,” admits Dr. Alvarez. “Prior to the development of this type of drug, the only drugs available to treat HCV were ineffective, toxic and poorly tolerated, requiring a year of side effects and toxicity to qualify for a 50% cure rate. “for the body,” the expert emphasizes.

But now, researchers, having studied a total of 229 people co-infected with HIV and HCV, along with a control group of people with HIV of similar size and characteristics, were able to conclude that successful elimination of HCV with DAAs significantly improves prognosis. regarding comorbidities and survival in individuals with HIV/HCV co-infection, the similarity of the prognosis of these patients to that of the comparison group suggests the importance of intensifying efforts to detect early HCV infection. highlighted. HCV and early initiation of radical treatment, accompanied by promotion of a healthy lifestyle. “This approach will not only have an impact on preventing liver damage, but more holistically will improve the overall health and life expectancy of affected individuals,” says Dr. Alvarez.

Finally, Dr. Rallón emphasizes the importance of the interdisciplinary and collaborative work of the research team composed of employees of the Fundación Jiménez Díaz and Rey Juan Carlos University Hospitals under the auspices of IIS-FJD/UAM. “We are building an interdisciplinary team of clinical and basic researchers, which is important for any translational research whose ultimate goal is to improve the quality of life of patients,” he adds, also thanking funding agencies and other research centers. with whom they collaborate, and mainly from volunteers and patients participating in research.