HIV:HCV Co-infection Landscape 21 of October, 09 Madrid,Spain. GESIDA, Madrid. Where are we are today?. Barriers to Care. HCV Treatment Uptake: John Hopkins HIV Clinic. 90% Genotype 1 70% African American Pop n . 35%. Referral associated with: ALT levels Undetectable HIV RNA
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Mehta AIDS (2006) 20:2361-69
Low dose RBV
Mean Change in Hgb After 4 Weeks HCV Therapy
RBV Dose Reduction During 1st 12 Weeks
Alvarez D et al. Journal Viral Hepatitis (2006) 13:683-689
Increased Side Effects
Increased Drug : Drug Interactions
Shortened Treatment Duration
Increased Regimen Complexity
Or will we have to wait for IFN and/or RBV – sparing regimens?
Simmen Poster 507, Int Liver Congress (2008)
Kempf AAC (2007) 18:163-167
Main Prioritization Criteria therefore:
Seiwert et al abstract T1793 DDW 2006
Pivotal Phase 3 Studies
Confirm Safety Profile
Phase 2/3 Co-infection Study
In vitro combination studies
Begin ART Drug:Drug Interaction studies of Priority Compounds
Complete ART Drug: Drug Interaction Studies
1-HIV/HCV CO-INFECTED PATIENTS SHOULD BE CONSIDERED FOR THERAPY NOW.
2-BASE TREATMENT DECISIONS ON STAGING,CO-MORBIDITIES AND VIROLOGIC RESPONSES.
3-ALL GENOTYPE 1 PATIENTS WITH SIGNIFICANT STAGING (F2 OR MORE ) SHOULD BE CONSIDERED FOR THERAPY NOW. ALL GENOTYPE 2/3 PATIENTS ,INDEPENDENT OF STAGING SHOULD BE TREATED TODAY.
4-BE AGGRESSIVE DEALING WITH CO-MORBID CONDITIONS, MOST ARE MANAGEABLE WITH ADDITIONAL PROFESSIONAL HELP ,AND MORE FREQUENT FOLLOW UPS.
5-PEG IFN ALFA 2a AND RBV TREAMENT CAN BE TAILORED ACCORDING TO VIROLOGICAL RESPONSE SHORTEN FOR RVR, LONGER FOR DELAYED RESPONSE.
6-NEW THERAPIES WITH SMALL MOLECULES ARE PROMISING BUT ARE 3 OR MORE YEARS AWAY, MOST HIV/HCV PATIENTS CAN NOT WAIT . TREATMENT WILL BE MORE COMPLEX AND MAY REQUIRE :NO ART, CHANGE IN ART OR IFN OR RBV SPARRING REGIMENS.