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AIDS Therapy Less Risky than Assumed

Even with secondary infection with hepatitis C more benefits than drawbacks

The immune deficiency syndrome AIDS can by now be treated successfully with effective drugs cocktails. Unfortunately, however, these involve the risk of dangerous side effects, as the drugs employed in this therapy may damage the liver. For those HIV patients, particularly, who in addition suffer from the inflammation of the liver known as hepatitis C, the \'highly active anti-retroviral therapy\' (HAART) has thus been hitherto regarded as risky - unjustifiably so, as researchers from the University of Bonn have now confirmed in the current issue of the prestigious medical journal The Lancet (vol. 362, p.168ff.). On the contrary, AIDS patients who were additionally suffering from hepatitis C and were subjected to the HAART treatment died of liver complications in the course of the twelve-year study even less often than patients who were subjected to less effective or no therapy at all. The findings have great practical significance: in Europe and the US it is estimated that every third HIV patient is simultaneously infected with the hepatitis C pathogen.

The researchers had observed a total of 285 patients with AIDS and hepatitis C over a period of 12 years. A good 80% of those under observation were suffering from a blot clotting deficiency. 93 patients were treated with HAART, 55 with less effective drugs; 137 were not treated with any drugs at all. HAART refers to a therapy consisting of treatment with a combination of different drugs which inhibit important virus enzymes, thus appreciably slowing down the increase of the HIV viruses in the body. The drugs reduce the number of viruses in the blood; the immune system is given a breathing space. At the same time, however, this drugs cocktail may be detrimental to the liver - especially when the liver cells have to fight a hepatitis C infection anyway. 

Reduced risk of dying from hepatitis C

\'HAART really does put a big strain on the liver cells,\' Bonn internist Professor Ulrich Spengler explains. Thus, in 13 out of of the 93 HAART patients there were serious hepatic reactions; six of them had to interrupt the therapy, although they were able to continue with a modified cocktail of drugs after a one-month interval. At the same time, however, the study showed that the HAART treatment appreciably reduced the danger of a fatal outcome of chronic hepatic infection with the hepatitis C virus: among the untreated patients not only was the total mortality four times as high as among the HAART patients, a severe impairment of the function of the liver was also the cause of death in this group in just under four times as many cases.

\'However, we do not know in detail why that should be the case,\' Professor Spengler admits. Perhaps the progress of hepatitis is more severe in cases of a weakened immune system. If, during the HIV treatment, the immune system recovers, this might have positive effects on the hepatitis. However, a counter-argument is that in the course of the HAART treatment the hepatitis virus count in the patients\' blood increased appreciably - far more so than in the control groups, which had been treated using less aggressive drugs or no drugs at all,\' Professor Spengler added.

\'There can be no doubt that there is a danger of toxic damage to the liver from the drugs administered using the HAART method,\' is how Professor Spengler summarises the results. \'Nevertheless, the positive benefits of the therapy far outweigh the drawbacks - both for the progress of the immune deficiency and that of the hepatitis.\' The Lancet comments therefore that there must be no question of avoiding the use of the aggressive cocktail of drugs used in the HAART method, even in the case of hepatitis C patients. However, the aim must be to develop new drugs to combat HIV which place less strain on the liver.

Contact partner:
Professor Ulrich Spengler
Medical Clinic and Polyclinic I of the University of Bonn
Tel.: ++49-228-2875850
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