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Patients infected with both HIV and hepatitis C virus lose more weight than those with only one of the infections

About one-third of patients with HIV are coinfected with hepatitis C virus (HCV). Patients treated with multiple antiviral agents for both HIV and HCV infection are more likely to suffer significant weight loss patients treated for either HCV or HIV alone, according to a new study. The addition of the anti-HCV nucleoside analogue ribavirin to treat HCV to a highly active antiretroviral therapy (HAART) regimen for HIV, which already contains one or more nucleoside reverse transcriptase inhibitors (NRTIs), may worsen weight loss.

Clinical observations have suggested that ribavirin might potentiate mitochondrial damage in subcutaneous adipose tissue when used with other nucleoside analogues. This can lead to lipoatrophy (loss of fat in specific parts of the body such as the face, arms, legs, and buttocks) and weight loss.

Researchers retrospectively studied 63 HIV-HCV coinfected patients, 64 HCV-monoinfected patients, and 65 HIV-monoinfected patients from 4 Philadelphia hospitals. They calculated whether the degree of weight loss among patients with HIV/HCV receiving HAART and pegylated (PEG)-interferon plus ribavirin was greater than in HCV monoinfected patients receiving PEG-interferon plus ribavirin and HIV monoinfected patients receiving HAART. They also examined risk factors for weight loss.

Body weight for HIV/HCV-coinfected and HCV-monoinfected patients was stable before initiation of HCV therapy. However, both groups lost weight after HCV treatment began, with the rate of weight loss being greater for dually-treated HIV/HCV subjects. The median loss in body weight from baseline was greater in dually-treated HIV/HCV-coinfected subjects compared to treated HCV-monoinfected subjects and treated HIV-monoinfected subjects.

In addition, 76 percent of dually infected patients had clinically significant weight loss (5 percent or more of baseline body weight) a year after therapy compared with 39 percent of patients with HCV and 3 percent of HIV patients. Receipt of 3 or 4 NRTIs by dually infected patients increased the risk of clinically significant weight loss over 8-fold. This suggests that mitochondrial toxicity might play some role in weight loss during dual HIV/HCV therapy.

Additional risk factors such as anorexia, depression, and dietary changes, may be contributing to this adverse effect. The duration of NRTI use and ribavirin dose were not risk factors for weight loss. No individual NRTI increased the risk of clinically significant weight loss. The study was supported in part by the Agency for Healthcare Research and Quality (HS10399).

See "Incidence and risk factors for weight loss during dual HIV/hepatitis C virus therapy," by Vincent Lo Re, III, M.D., M.S.C.E., Jay R. Kostman, M.D., Robert Gross, M.D., M.S.C.E., and others, in the March 1, 2007 Journal of Acquired Immune Deficiency Syndromes 44(3), pp. 344-350.

Editor's Note: Another AHRQ-supported study (HS10399) by the same researchers found that self-reported hepatitis B and C virus infections among HIV-infected injection drug users (IDUs) and non-IDUs did not sufficiently match HBV and HCV infection on blood tests to warrant using self-report to estimate the prevalence and incidence of these infections. For more details, see: Lo Re III, V., Frank, I., Gross, R., and others (2007, March). "Self-reported hepatitis B and C virus infections had low sensitivity among HIV-infected patients." Journal of Clinical Epidemiology 60, pp. 294-299.

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