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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



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Evolution of Coinfection with Human Immunodeficiency Virus and Hepatitis C Virus in Patients Treated with Highly Active Antiretroviral Therapy [Torre D et al. CID 2001;33:1579] This is a retrospective review from Italy concerning the impact of HAART on the course of HCV infection in a cohort of 323 co-infected patients who were followed for at least two years. The results showed no significant changes in ALT or in serum levels of HCV RNA. Of the 323 participants, 15 (4.6%) died in three years and the cause of death was attributed to cirrhosis in 5 (1.6%). Patients with ALT levels over four times the ULN showed significant decreases in ALT, and those with normal ALT at initiation of HAART showed a significant increase in ALT over time. The authors conclude that HAART has little effect on the natural history of HCV, but there may be long-term benefit or detriment depending on the baseline ALT.
Comment: Prior studies that address this issue have shown variable results. This is one of the larger studies, but is also retrospective. The overall impact of HAART on HCV was minimal. Further, the results were approximately the same with and without immune restoration following HAART.
posted 11/19/2001





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