HCV and HIV coinfection treatment

HCV and HIV coinfection treatment

More than 57 million people are reported to be infected with the liver illness known as Hepatitis C virus (HCV) worldwide almost every year. The number of deaths brought on by this persistent infection is also staggering. Hepatocarcinoma, end-stage liver disease, and hepatic cirrhosis are all made worse by chronic hepatitis C.

Direct-acting antivirals (DAAs), a revolutionary class of drugs, have been crucial in containing this epidemic since they work even on patients with advanced liver cirrhosis brought on by HCV. Did you know, though, that the majority of infected individuals are unaware of their disease and that the minority who are aware do not receive the appropriate care?

Describe the hcv-hiv coinfection.

Another issue to take into account while talking about HCV infections is HCV coinfection with HIV. The risk of acute HCV infections has increased globally in recent years among particular subgroups of HIV+ patients, including PWID (people who inject drugs) and MSM (men who have sex with men), sex workers, and those engaged in hazardous sexual behaviours. HIV-infected people are more susceptible to HCV infection due to their compromised immune systems, which also contributes to the disease's rapid progression to liver cirrhosis and hepatocellular cancer.

A general indicator of the severity of the situation is that HCV infections are to blame for 90% of liver disease-related fatalities in non-AIDS HIV+ individuals in the US. As a result, medical treatment for those with HCV and HIV coinfection has risen to the top of the medical agenda.

In one of our earlier articles, we discussed seroconversion and how to avoid HIV.

A quick word: HHC provides an extensive range of SEROCONVERSION PANELS for detecting asymptomatic donors infected with HIV, HCV, HBV and EBV, and SURVEILLANCE PANELS and LONGITUDINAL PANELS are helping labs diagnose these diseases effectively. Our panels are run on as many different diagnostic kits as possible to measure relevant markers of seroconversion.

In this article, HHC throws light upon the various HCV and HIV coinfection treatment regimens to help curb the increasing mortality rates of coinfected patients.

What are the different treatments for hepatitis c virus-hiv-coinfection?

Some of the following treatments are utilised to treat both HCV monoinfected patients and HCV-HIV coinfected patients. While most treatments are effective, they may also have certain shortcomings.

Due to the added complexity of coinfection with HIV, the treatment pattern for HCV-HIV patients is different. Before suggesting medication to such patients, it is essential to determine the viral load and genotype following serological diagnosis of HCV infection. The duration of treatments varies based on findings from the above investigations.

HHC is a leading supplier of serological controls. With the help of our range of serological controls – the SeraCon Run Controls, labs worldwide can flawlessly assess the performance of immunoassay test procedures for the qualitative determination of HBsAg, anti-HIV and anti-HCV.

Interferon and Ribavirin

Though this therapy has been traditionally and primarily practised for treating HCV monoinfected patients, in recent decades, they have also been used to treat the coinfected population. The treatment works, but not without side effects. Interferon can provoke side effects such as tiredness, muscle or joint pain, fever and other flu-like symptoms, loss of white blood cells, nausea or diarrhoea, skin rash, depression, and thinning hair.

Ribavirin is contraindicated in female patients who are pregnant or want to get pregnant and can cause anaemia. In addition, this combination treatment was challenging, lasted a long time (6 to 12 months), could only cure half of the patients under treatment and was mainly administered to patients with high chances of a progression of liver disease.

Direct-Acting Antivirals (daas)

direct-acting antivirals (daas)

Direct-acting antiviral (DAA) drugs can now successfully treat the majority of hepatitis C patients, regardless of their age, race, sex, or HIV status. DAAs have little side effects, making them safe to use and non-interfering with HIV treatment. A DAA therapy regimen may last up to 12 weeks.

Some DAAs can be used as a once-daily combination drug (commonly referred to as "pangenotypic") and are effective against all genotypes of hepatitis C.

The most recent DAAs can treat and cure more than 90% of chronic hepatitis C infections because they target and attack HCV at different phases of the hepatitis C reproduction and lifespan. These include NS5A inhibitors, polymerase inhibitors, and hepatitis C protease inhibitors.

It is important to note that, similar to HIV therapies, a combination of drugs is more successful at preventing any potential resistance because they each have unique mechanisms of action. As a result, the majority of DAAs are only offered in combination medications. Contrary to HIV therapy, Hepatitis C treatment can completely cure the patient.

What are the different types of the DAAs available in the market?

Boceprevir and Telaprevir were the first DAAs or hepatitis C protease inhibitors approved in 2011. Their range of use was limited to hepatitis C genotype 1 and had to be combined with interferon and ribavirin. These drugs are not recommended anymore.

Some of the recent and better DAA treatments (single and combination) are:

• sofosbuvir (Sovaldi)

• daclatasvir (Daklinza) (could be combined with sofosbuvir)

• simeprevir (Olysio) (could be combined with sofosbuvir)

• sofosbuvir and ledipasvir (Harvoni)

• paritaprevir + ritonavir + ombitasvir (Viekirax) + dasabuvir (Exviera)

• elbasvir + grazoprevir (Zepatier)

• sofosbuvir + velpatasvir (Epclusa)

• glecaprevir + pibrentasvir (Maviret)

• sofosbuvir + velpatasvir/voxilaprevir (Vosevi)

In 2013, the FDA approved simeprevir (Olysio, Janssen) and sofosbuvir (Sovaldi, Gilead). In 2014 a fixed-dose combination of ledipasvir and sofosbuvir (Harvoni, Gilead) was approved. The approved DAAs target genotype 1 and are also effective against genotype 4, except for sofosbuvir + velpatasvir or sofosbuvir + daclatasvir, which are beneficial for genotypes 2 or 3. In some cases, ribavirin could be added to combinations, for instance, for patients with cirrhosis or prior treatment, to increase the possibility of a cure.

What are the results of DAA regimens, and how successful are they?

Clinical studies show that the suggested DAA combo regimens have an overall effectiveness rate of 95 to 100 percent. The condition has been cured if, after 12 weeks, the virus is undetectable in patients who received a sustained virological response (SVR). Although SVR rates are lower for some individuals whose liver disease is progressing quickly, most patients eventually receive treatment thanks to the most recent DAAs.

In other cases, getting well could require a longer treatment duration or a drug regimen with more pills. If the first try fails, some patients might be cured on the second. There are not many negative effects while using DAAs without Interferon therapy. Common side effects include mild fatigue, gastrointestinal issues, and headaches. These issues typically go away once the treatment is over, which benefits the patient.

How to cure HCV-HIV coinfections, according to experts?

The same treatment guidelines must be followed for patients with HCV monoinfection and HCV-HIV coinfection, according to medical specialists. However, therapy for coinfected patients needs to be prioritised in order to battle the crippling effects of HCV-HIV coinfection.

Antiretroviral therapy (ARV) must be started as soon as possible for all HIV patients, including those who are also co-infected with HCV and HIV. Beginning an ARV regimen in a timely manner helps boost immunity and manage HIV symptoms, which may be especially helpful for individuals who are also coinfected by lowering the risk of liver disease progressing quickly.

Currently, DAA regimens are advised for all coinfected individuals as a starting point, and this recommendation is made even more urgently if the patient has moderate or severe liver fibrosis. Concurrent ARV and HCV treatment regimens are acceptable, and the former cannot be stopped in order to begin the latter. A proper HCV treatment strategy for a patient who also has HIV must take into account the HIV ARV regimen in addition to the initial genotype studies and serological diagnosis. It is crucial to make sure that the regimens suggested for treating the two viruses do not result in drug resistance, harmful interactions, or side effects.

Only with better health services is a better future conceivable. For your lab to deliver precise test results for diagnosis, you need QUALITY CONTROL PANELS.

HHC offers you a variety of panels that can be utilised for the creation of diagnostic tests, batch release in manufacturing, or to offset the sensitivity, specificity, and working range of your assays. Representative data from recently released assays are included in our panels. Additionally, depending on the panel's intended usage, our variety of VERIFICATION / VALIDATION panels is made to work with assays to find the presence of antigen, antibody, RNA, or DNA. Domestic and international regulatory bodies, as well as Certified Reference Laboratories, conduct all testing.

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