Three patients coinfected with hepatitis C virus and HIV spontaneously became negative for HCV RNA while undergoing antiretroviral therapy, and all had the IL28B CC genotype in a recent study.
In establishing their study, researchers in Sweden wrote, “Spontaneous clearance of a chronic HCV infection without HCV treatment is a rare event with only few case reports in HIV/HCV coinfected patients published.” They selected the patients from an HCV/HIV coinfected cohort (n=466), and all three cases were among the IL28B CC genotype-tested group (n=64) who underwent antiretroviral therapy (ART).
Patient one, aged 58 years, was a homosexual male who began ART (raltegravir, tenofovir, emtricitabine) in February 2010 after seroconverting to HIV and HCV in 2008. Within 3 months, the investigators said he was HCV RNA negative.
The second patient, aged 62 years, used intravenous drugs and initiated ART in 1997, after being diagnosed with HIV in 1985 and HCV genotype 2b in 1993. In 2008, the woman spontaneously became HCV RNA negative while receiving atazanavir/ritonavir, abacavir and lamivudine. She remained negative throughout 4 years.
The third patient, aged 48 years, was diagnosed with HIV in 1985 and HCV genotype 2b in 1997 and remained positive for HCV through 2004. She had been undergoing ART in 1996 and was HCV RNA negative in 2005 while being treated with lopinavir/ritonavir, stavudine and tenofovir. This patient continued to be negative for 18 months.
After testing negative for HCV RNA for the first time, all patients remained negative for three additional tests.
“We argue that HIV/HCV coinfected patients probably should commence ART prior to HCV treatment, in particular if they have the IL28B CC gene, since it might occasionally induce spontaneous HCV clearance of a chronic HCV infection,” the researchers wrote. “HCV RNA testing should be recommended immediately before initiation of HCV treatment, to find the subset of HIV/HCV coinfected patients with IL28B CC that may have cleared their chronic infection spontaneously.”
Disclosure: The researchers report no relevant financial disclosures.