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Management of HCV Infection in the HIV-Infected Patient: Where Are We in 2010?
Slide Presentation
May 12, 2010
Phyllis C. Tien, MD

Click on slide thumbnails to view full-size image.

Slide 1.
Management of HCV Infection in the HIV-Infected Patient: Where Are We in 2010?
Slide 1.
Goals of Talk
Slide 2.
Background
Slide 3.
Liver Disease Is the Leading Cause of Non-AIDS-Related Deaths in the HAART Era
Slide 4.
Liver Fibrosis Progression Rate Appears Increased in HIV/HCV vs HCV
Slide 5.
Natural History of HCV Infection
Slide 6.
Percent of Active HIV+ Patients Tested for HCV Has Increased; Percent Found HCV Ab+ by Year Has Decreased (HIV Outpatient Study, 1996-2007)
Slide 7.
Distribution of Chronic or Resolved HCV by Risk Group & Year: % of HCV Infection in IDU Has Decreased (HIV Outpatient Study, 1996-2007)
Slide 8.
Time to Initiation of HCV Treatment by Baseline Period (Beginning of Observation) Decreased & Proportion on Rx Is Greater (HIV Outpatient Study, 1999-2007)
Slide 9.
Case #1: 55-Year-Old, Previously Healthy Non-IDU MSM with F, Sore Throat, Myalgias, Arthralgias & H/O Unprotected Receptive Anal Intercourse in 10/02
Slide 10.
Recognize Acute HCV Infection
Slide 11.
Increased Incidence of Acute HCV Infection among HIV+ MSM: Transmission Mucosal, Not Parenteral
Slide 12.
Treatment Response Rates in Acute HCV Infection Are Higher Than in Chronic HCV Infection in HIV
Slide 13.
Treatment of Acute HCV: When to Start?
Slide 14.
Treatment of Acute HCV: How to Start?
Slide 15.
Case #2
Slide 16.
What Factors Should Be Considered in the Assessment for Treatment?
Slide 17.
Characteristics of Persons for Whom Therapy Is Currently Contraindicated
Slide 18.
Characteristics of Persons for Whom Therapy Should Be Individualized
Slide 19.
Barrier to HCV Treatment in an Urban HCV/HIV Clinic
Slide 20.
What Factors Should Be Considered in the Assessment for Treatment?
Slide 21.
Liver Biopsy
Slide 22.
Liver Biopsy
Slide 23.
HIV/HCV with >F1 Fibrosis at Increased Risk of Clinical Events (ESLD, HCC, or Death)
Slide 24.
Pre-Treatment Assessments: Liver Biopsy
Slide 25.
Nearly 1/3 of 51 HIV/HCV Patients with Stage 0 or 1 at Baseline Progressed to Stage 2 or Higher Fibrosis (Median 1.84 Years)
Slide 26.
Limitations to Liver Biopsy
Slide 27.
Fibroscan (or Transient Elastography)
Slide 28.
Biochemical Markers of Hepatic Fibrosis also Under study
Slide 29.
What Factors Should Be Considered in the Assessment for Treatment?
Slide 30.
HCV Treatment Response in HIV Infection
Slide 31.
Pre-Treatment Factors Associated with Response to HCV Therapy
Slide 32.
IL28B Gene Polymorphism (CC Allele) Associated with 2-Fold Higher SVR Regardless of Ethnicity
Slide 33.
Response Rate in HIV/HCV with Recent HCV Infection
Slide 34.
HCV Reinfection
Slide 35.
Case #2
Slide 36.
Current HCV Treatment Recommendations in HIV
Slide 37.
Major Adverse Effects of HCV Treatment
Slide 38.
Treatment Monitoring Guidelines
Slide 39.
Treatment Monitoring of HCV RNA
Slide 40.
RVR & Complete EVR Are Strong Predictors of SVR
Slide 41.
Proposed Optimal Duration of Hepatitis C Therapy in HCV/HIV-Coinfected Patients
Slide 42.
Case #2
Slide 43.
Summary
Slide 44.
HCV Treatment Summary
Slide 45.
Investigatonal Anti-HCV Strategies: To Improve Response, Ease Administration &, Decrease Side Effects
Slide 46.
Important Targets for DAA Therapy in the HCV Genome
Slide 47.
Investigational DAA Agents
Slide 48.
PROVE 1 and 2: Telaprevir Results -- Treatment-Naïve Genotype 1-HCV Monoinfected
Slide 49.
Telaprevir Adverse Events
Slide 50.
Phase 2 SPRINT-1: Boceprevir Results -- Treatment-Naïve Genotype 1-HCV Monoinfected
Slide 51.
Boceprevir Adverse Events
Slide 52.
Potential Interactions between ARVs and DAA Agents
Slide 53.
Summary
Slide 54.
Internet Resources
Slide 55.

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