Occasional spontaneous clearance of chronic hepatitis C virus in HIV-infected individuals

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

62-year-old woman with intravenous drug use (idu) 15 years earlier was diagnosed with HIV in 1985 and HCV genotype 2b in 1993 HCV-RNA was repeatedly positive betweenn 2003 and 2007 and the HCV-RNA level fluctuated between

Clinical Characteristics

Low CD4+ tcell count was 240 x 109/l had an aminotransferase flare in december 2007

Remission Characteristics

In 2008, when HCV treatment was planned to start, HCV-RNA had spontaneously become negative. After this she has been continuously negative for HCV-RNA during 4 years her art regimen at the time of HCV-RNA clearance was atazanavir/ritonavir, abacavir and lamivudine and the CD4+ t-cell count was 438 x 109/l

Treatment & Mechanisms

Proposed Remission Mechanisms

Immune related

Clinical Treatment

Had been on highly active art since 1997 obv (25 mg per day), ptv (150 mg per day), and ritonavir (100 mg per day)