Spontaneous HCV clearance in a patient with HIV infection and a concurrent, never treated, evolutive HCV hepatitis, after over twenty years of chronic co-infection
Retrovirology volume 7, Article number: P86 (2010)
The reciprocal virological-immunological interactions between HIV and HCV, as well as the reciprocal effect of the specific antiviral therapies, are still poorly known. A rare case report of spontaneous clearance of HCV occurred in an ex-IVDA co-infected with HIV-HCV since 20 years, and never treated for HCV, is presented.
A 49-year-old ex-IVDA patient (p) tested HIV-HCV positive since 1989, and was treated for HIV disease since 1990 with limited compliance until 2 years ago. He never attained undetectable HIV viremia until the last 6 months, although CD4+ T-lymphocyte count steadily remained >300 cells/μL.
Until this last semester, against medical recommendation, our p continued alcohol consumption and irregular drug addict, despite an ongoing methadone program. Serum transaminases showed fluctuating values, always >2-3.5-fold normal levels, while HCV replication was confirmed by values of 1,200-4,000 × 103 IU/mL. During the last 6 months, our p first abandoned its former lamivudine-zidovudine-nevirapine therapy, leading to a combination including 2 novel nucleos(t)ide analogues (tenofovir-emtricitabine), associated to the protease inhibitors (PI) lopinavir-ritonavir, and finally in the last 3 months due to gastrointestinal intolerance-hypertriglyceridemia he introduced fosamprenavir-ritonavir on behalf of lopinavir-ritonavir. Already after lopinavir-ritonavir use, our p attained undetectable plasma HIV-RNA levels (always confirmed thereafter), while CD4+ count showed the greatest values even registered by our p (513-662 cells/μL). During 2 subsequent controls, qualitative HCV viremia tested negative for the first time, concurrently with normal transaminases.
Single cases of apparent disappearance of a chronic HCV infection in HIV-HCV co-infected p in absence of anti-HCV therapy have been described as anecdotal reports. In these episodes, a role of anti-HIV therapy (without reference to speficic drugs and associations), and that of a concurrent, significant immune recovery was often claimed. The eventual role of HIV PI, although a negligible direct anti-HCV is known, is still debated, depending on the direct-indirect role possibly played by PI in the dynemics of HIV-HCV co-infection. Fosamprenavir is a PI with contained liver toxicity, thus recommended just in p with a concomitant chronic hepatis/liver cirrhosis. A systematic revision of safety databases of fosamprenavir in HIV-infected p with chronic viral hepatitis (to detect eventual virological-immunological changes of the concomitant HCV hepatitis), and a systematic appraisal of all literature anecdotal case reports, may shed light on novel research targets in this relevant, but somewhat unexplored situation.
About this article
Cite this article
Manfredi, R., Dentale, N. & Calza, L. Spontaneous HCV clearance in a patient with HIV infection and a concurrent, never treated, evolutive HCV hepatitis, after over twenty years of chronic co-infection. Retrovirology 7 (Suppl 1), P86 (2010). https://doi.org/10.1186/1742-4690-7-S1-P86