Occasional Spontaneous Clearance Of Chronic Hepatitis C Virus In Hiv-infected Individuals
Stenkvist, J., Nyström, J., Falconer, K., Sönnerborg, A., & Weiland, O. (2014). Occasional spontaneous clearance of chronic hepatitis C virus in HIV-infected individuals. Journal of hepatology, 61(4), 957–961. https://doi.org/10.1016/j.jhep.2014.06.014
View Original Source →Abstract
The IL28B genotype has been found to have a strong influence on spontaneous clearance of acute HCV both in HCV mono- and HIV/ the HCV co-infected patients. Spontaneous clearance of chronic HCV without HCV treatment is rare. Here, we report on three chronic HCV cases co-infected with HIV with spontaneous clearance of their HCV infection, all with the IL28B CC genotype. These cases were derived from a surveillance of the total HIV/HCV co-infected cohort in Sweden (n =4 66). The estimated frequency of spontaneous clearance of chronic HCV infection in our cohort was calculated to be 0.6-4.7%. Our cases lend some support to the initiation of ART prior to HCV treatment in HIV/HCV co-infected patients. Furthermore, HCV-RNA testing should be recommended immediately before initiation of HCV treatment, to find the subset of HIV/HCV co-infected patients with IL28B CC that may have cleared their chronic infection spontaneously.
Case Details
Disease Location
Liver
Personal Characteristics
58 year-old homosexual male seroconverighted simultaneously for both HIV and HCV genotype 4 in july 2008
Clinical Characteristics
Had fluctuating HCV-RNA levels between 847,000, 268,000, and 3,700,000 iu/ml repeatedly during 2008–2010 had markedly elevated aminotransferases in august 2009 when a liver elasticity measurement by fibroscan showed a mean elasticity of 16.9 kpa indicating cirrhosis and/or active inflammation
Remission Characteristics
The flare subsided within 2 months (22 months after the HCV diagnosis) and HCV-RNA became negative was restarted with the same art regimen and had no flare reaction. Hereafter, HCV-RNA has repeatedly been tested negative during 2 years
Treatment & Mechanisms
Proposed Remission Mechanisms
Immune related
Clinical Treatment
Art (raltegravir, tenofovir, and emtricitabine) was started in february 2010 when his CD4+ t-cell count was 384 x 109/l, but was interrupatiented after one months due to an alt flare