UK-CAB 39: London HIV drug prescribing and Hepatitis C

Programme

Introduction:

Hepatitis C is a blood-borne virus that predominantly infects the cells of the liver. This can cause inflammation of and sometimes significant damage to the liver and affect its ability to perform its many, varied and essential functions. Although it has always been regarded as a liver disease (hepatitis means inflammation of the liver). Cirrhosis may also lead to liver failure. In this case, a liver transplant may be the only option.

Kidney disease is a common problem for people with HIV, particularly as they get older. Depending on how severe the kidney disease is, a variety of options are available, ranging from diet changes to a kidney transplant. Some choices, such as a kidney transplant, were once thought to be too risky, but are now increasingly available to people with HIV. Up until the mid-1990s, physicians tended to avoid giving kidney transplants to HIV patients because of fear that AIDS would quickly kill them. There are studies that show that this is now feasible.

Some questions we look forward to being answered include:

• Why should HIV positive people be concerned about HIV-HCV coinfection?
• Who is likely to have HIV-HCV coinfection?
• What are the effects of coinfection on disease progression of HCV and HIV?
• How can coinfection with HCV be prevented?
• How should patients coinfected with HIV and HCV be managed?
• What research is needed on HIV-HCV coinfection?
• Does HIV impact survival after liver transplant?
• Is there likely to be a Hep C re-infection after transplant?
• Who gets priority for a liver transplant?
• Is there a way to expedite a transplant?
• Why should people with HIV care about kidney disease?
• How do I know if there are problems with my kidneys?
• Are there any drug interactions between the ARVs and immunosuppressants?

Background reading

Guide to Hepatitis C for people living with HIV (March 2009)

http://i-base.info/home/hepatitis-c-guide/

This is the updated i-Base guide for people with HIV/HCV co-infection with much of the writing done by people living with HIV, hepatitis C or co-infection, with a positive outlook for management and treatment.

Rapid report: state of HCV policy, treatment, access

http://i-base.info/htb/14992

HTB article on pipeline drugs for Hepatitis C.

London: cases of bad patient care from new guidelines
http://i-base.info/home/london-cases-of-bad-patient-care/

Changes to HIV drug prescribing in London
http://i-base.info/home/changes-to-hiv-drug-prescribing-in-london/

Liver transplants in HIV positive people:

Summary of the liver’s functions:

Easy to read non-scientific function of the liver – you can jump easily to different section and has some information on liver transplants.

Outcomes of liver transplantation in HIV positive recipients co-infected with Hep B or C

http://www.hivandhepatitis.com/2009icr/croi/docs/032409_b.html

This is a report from CROI 2009 comparing five-year survival data of HIV positive people after liver transplants from Spain and France.  It also looks at liver cirrhosis data from HIV positive and negative patients.

Treatment of recurrent hepatitis C after liver transplantation

http://www.hivandhepatitis.com/hep_c/news/2011/0218_2011_a.html

Study on showing that Hepatitis C patients with advanced liver disease may benefit from interferon-based therapy before receiving a liver transplant, but side effects are common and response rates are low. Injected antibodies do not prevent the new liver from becoming infected, but pegyalted interferon plus ribavirin can cure recurring HCV about 30% of the time.

PROTECT study finds one-third of liver transplant patients achieve sustained response to pegylated interferon plus ribavirin

http://www.hivandhepatitis.com/2010_conference/easl/docs/0504_2010_b.html

Study showing that ART with pegylated interferon alfa-2b (PegIntron) plus ribavirin led to undetectable HCV viral load in about 30% of hepatitis C patients after liver transplantation. A similar proportion, however, were unable to complete therapy due to adverse events.

Kidneys and how they function

http://kidney.niddk.nih.gov/Kudiseases/pubs/yourkidneys/#kidneys

A starting point to understand all about how kidneys work, what tests determine kidney function and some information about the transplantation process. Rather long but easy to navigate through sections.

HIV and kidney disease

http://www.aidsinfonet.org/fact_sheets/view/651

Easy to read article with kidney information for HIV positive people.

Kidney transplant ‘feasible’ for patients with HIV

http://www.aidsmap.com/print/Kidney-transplant-feasible-for-patients-with-HIV/page/1549661/

This is a report showing good survival rates of HIV positive patients after kidney transplants.

Renal transplantation in patients with HIV [PDF, 212 KB]

This review examines open questions on kidney transplantation in patients infected with HIV-1 and clinical strategies that have resulted in good outcomes. It also describes the clinical concerns associated with the treatment of renal transplant recipients with HIV. A long document with a bit of science but has good key points after each section.

Financial support

The UK-CAB receives unrestricted funding from some pharmaceutical companies towards the direct costs of holding four meetings each year. This funding supports the travel and accommodation costs for members to attend from outside London, plus the cost of catering.

The content, programme and agenda for meetings is decided by the UK-CAB steering group in consultation with the wider membership. Funding is unconnected to meeting content.

We believe that manufacturers who currently develop and market medicines have a responsibility to actively engage with advocacy organisations and that HIV positive people and their advocates should be able to directly question manufacturers about the safety and efficacy of their products and proposals for future research.

For a list of companies that support the UK-CAB please see the “about us” page.