Clinical course and efficacy of antiretroviral therapy of combined bloodborne pathology: human immunodeficiency virus and chronic hepatitis C

Abstract

Objective: To study the main epidemiological, clinical and laboratory features of the manifestations and course of hepatitis C and HIV infection as a mixed pathology, development and substantiation of epidemiological diagnosis algorithm, treatment and prevention.

Materials and Methods. To perform this work, a clinical and laboratory examination of patients with HIV infection and chronic viral hepatitis C was carried out, who were observed at the AIDS Prevention and Control Center in Odessa in 2015–2016. All patients were examined clinically (complaints, anamnesis, history of life and epidemiological anamnesis, objective examination) and basic laboratory and instrumental investigetions, in accordance with the standards of patients with HIV infection examination. Three main clinical groups were identified: 1) patients with chronic viral hepatitis C (CVHC) – 41; 2) patients with HIV infection (HIV) – 58 people; 3) patients with mixed infection (HIV + CVHC) – 81 people. All patients with HIV infection were given treatment with Aluvia and Kaletra (lopinavir 200 mg and ritonavir 50 mg) 2 tablets twice a day (800/200 mg) orally.

Results. Pre-existing viral liver disease increases the risk of potential hepatotoxicity of antiretroviral drugs realization; on the other hand, a number of drugs for HIV infection treatment may alter the pharmacokinetics of other drugs independently influencing on cytochrome P450, inhibiting or stimulating their activity. At the same time, the interaction of these drugs could be put to more profitable use in the combined therapy to maintain of antiretroviral medications appropriate plasma concentrations. Antiretroviral therapy for chronic hepatitis C and HIV-infected patients becomes important, due to the possibility of eradicating HCV infection, delayed progression of viral damage of the liver to prevent fibrosis, cirrhosis, decompensation development and onset of death.

Conclusions. Early antiretroviral HCV therapy in co-infected patients due to the compensation of hepatic functions may improve the tolerability of subsequent antiretroviral therapy and reduce its hepatotoxic potential, thereby positively affecting the commitment of patients to treatment, improve the effectiveness of therapy by reducing the incidence of HIV-associated morbidity and mortality.