The Effect Of HIV Coinfection On The Anti HCV Therapy For Chronic HCV Patients

Background:Because HCV (Hepatitis C Virus) and HIV (Human Immunodeficiency Virus) have similar routes of transmission (blood, sexual contact, mother to infant vertical transmission, etc.), HCV/HIV co-infection is very common. Currently, there are many researches on HCV/HIV co-infection, but they mainly focus on the HCV/HIV co-infection rate as well as the relationship between HCV/HIV genotyping and their routes of transmission and there are few researches on the therapeutic effect and its side effects of the treatment for chronic HCV patients co-infected with HIV.Purpose:To study the Interferon combined with ribavirin therapy on anti HCV therapy in patients with chronic hepatitis C with HIV infection effect.Methods:Take as chronic HCV patients selected from Ruzhou People’s Hospital and the Sixth People’s Hospital of Zhengzhou City treated from October,2012 to October,2014. Among them, there are 28 cases of HIV co-infection, and the other 28 cases of simple HCV were randomly selected as reference. All the results of anti-HCV test and HCV-RNA test on every group of patients were positive. As to the co-infection group, all the anti-HIV tests were positive, which were confirmed by Western blotting analysis; no AIDS-related complications; CD4+T cell counts> 350/ul; HIV RNA:Lower detection limit/ml; and the treatment plan was adjusted by anti-HIV drugs without zidovudine and nevirapine. All the patients were made a definite diagnosis by local CDC (Chinese Center for Disease Control and Prevention), and voluntarily signed an informed consent form for anti-HCV treatment. According to the therapy of common interferon combined with ribavirin recommended by Chinese Hepatitis C Prevention Guide (2004):"common interferon 2b 600MU, subcutaneous injection every other day, combined with oral ribavirin 1000mg/d, treatment 48 weeks", respectively in the 0,12th,24th,48th week of interferon combined with ribavirin treatment, test the blood HCVRNA load liver function and blood routine after 24 weeks of drug withdrawal. The criteria for therapeutic effect judgment is in accordance with the criteria of Hepatitis C Prevention Guide issued in 2004 by Chinese Medical Association (CMA):early virological response (EVR):in the 12th week after the completion of treatment, HCV-RNA is below the lower detection limit or the viral load declines; end treated virological response (ETVR):in the 48th week after the completion of treatment, HCV-RNA is below the lower detection limit; sustained virological response (SVR):in the 24th week after the completion of treatment and drug withdrawal, HCV-RNA is still below the lower detection limit. Use numerical changes to make statistic analysis on biochemical parameters and blood routine. Use SPSS 17.0 software to analyze all the data. Use X2 to exam the count data. Use logarithmic mean value to calculate the HCVRNA average copy numbers, indicated with log10(x). Use two independent samples t test the measurement data. Use mean±standard deviation to show the results.P>0.05 means there is no significant difference and P<0.05 means the difference has statistic significance.Results:Both the HCV load of HIV co-infection group and that of simple HCV infection group decline with the extension of anti-virus treatment. From the 24th week, the HCV-RNA decline degree of HIV co-infection group is lower than that of simple HCV infection group. With the end of anti-hepatitis C treatment and the appearance of recurrence cases, the HCV load of the both groups raise again from the 72th week, and the HCV load of HIV co-infection group rises higher than that of simple HCV infection group. The statistical comparison is P<0.05, which shows there is significant difference between the two groups. SVR (88.46%) of simple HCV infection group is higher than that of HIV co-infection group (56.00%), ETVR (96.15%) of simple HCV infection group is also higher than that of HIV co-infection group (72.00%), so there is significant difference between the two groups (P<0.05). The ALT、AST level of the groups both gradually declines with the extension of treatment. From the 48th week, the comparison of ALT、AST between the two groups has statistic difference (P<0.05), suggesting that with the extension of treatment and the improvement of liver function, the decline and recovery of the liver function of HIV co-infection group are worse than that of simple HCV infection group. The white blood cell (WBC) level of the groups both declines in different degrees with the extension of treatment. Comparing the decline degree of WBC level changes in the 12th,24th, and 48th week of HIV co-infection group and simple HCV infection group, there are significant difference (P<0.05). With the extension of treatment and the occurrence of side effects of anti-HCV, both the blood platelet (PLT) level and the hemoglobin (HGB) level of the two groups decline. Comparing the change of PLT level and HGB level in the 12th,24th, and 48th week, there is no statistic difference between the two groups (P> 0.05). the comparison of gastrointestinal reactions and flu-like syndrome also has no statistic difference(P> 0.05)。Conclusion:As to the chronic HCV patients co-infected by HIV with CD4+ cell counts> 350, anti-HCV treatment can achieve better results, but HCV viral decline and SVR of simple HCV infection group is better than that of HIV co-infection group; The decrease of liver function in patients with HIV infection and the poor recovery of liver function in patients with HCV infection; The WBC decline rate of HIV co-infection group is significantly higher than that of simple HCV infection group, and the therapeutic process should be paid close attention and timely treated; The comparison of PLT and HGB levels has no significant statistic difference, and the comparison of gastrointestinal reactions and flu-like syndrome also has no statistic difference.