D. Vittecoq

The pavia consensus statement

The intersection of cardiovascular disease and HIV infection is common and complex, yet inadequately understood. Considering and managing actual or potential cardiovascular illness in patients with HIV infection are important aspects of HIV care. As the diagnosis and management of cardiovascular disease is itself complex, specialists in this area of medicine may need to be consulted. They, in turn, need to be aware of the complex manifestations of HIV infection and the cardiovascular implications of HIV therapy. The bilateral nature of these interactions is an important issue considered in the present report.

Vapreotide, a somatostatin analogue, in cryptosporidiosis and other AIDS-related diarrhoeal diseases.

ObjectiveTo evaluate the efficacy and tolerance of vapreotide, a new somatostatin analogue, in the treatment of refractory AIDS-related diarrhoea. DesignAn open, non-comparative pilot trial. SettingThe trial was conducted in 10 medical centres in France. Patients, participantsThirty-four AIDS patients with chronic diarrhoea unresponsive to conventional antidiarrhoeal therapy were enrolled. Cryptosporidiosis was diagnosed in 21 out of 30 evaluable patients. Mean number of stools prior to therapy was 10.1 ± 4.9 per day (range, 3–20 stools per day). InterventionAfter initial baseline studies, patients received subcutaneous vapreotide at escalating doses of 400 (23 patients) or 500 üg (seven patients), between two and six times daily. Main outcome measuresEfficacy was assessed after 14 days of therapy, when it was found to be effective. Responders were offered the opportunity to continue receiving therapy. ResultsFour patients demonstrated a complete response and 12 a partial response with > 50% reduction in daily stool emission. Fourteen patients did not respond to doses up to 2400 ül/day. Patients with conditions other than cryptosporidiosis had a significantly higher probability of response (P = 0.013), as did those with milder diarrhoea (< 10 stools per day). Median duration of response was 1.5 months (range, 0.5–5 months); relapse occurred in five out of eight responders despite maintenance therapy. Toxicity was minimal. ConclusionsWe conclude that AIDS patients with diarrhoea not caused by Cryptosporidium may benefit from vapreotide therapy.

Therapy with boceprevir or telaprevir in HIV/hepatitis C virus co-infected patients to treat recurrence of hepatitis C virus infection after liver transplantation.

Objective:Severe hepatitis C virus (HCV) recurrence affects post-transplant survival in HIV/HCV co-infected patients. This article describes the results of triple anti-HCV therapy with boceprevir or telaprevir in seven HIV/HCV co-infected patients following liver transplantation. Methods:All patients had severe HCV recurrence [fibrosis stage ≥F2 or acute hepatitis ≥A2 (nu200a=u200a5) or fibrosing cholestatic hepatitis (nu200a=u200a2)] associated with genotype 1a (nu200a=u200a4) or 1b (nu200a=u200a3). Patients were treated with Peg-interferon/ribavirin and boceprevir (nu200a=u200a2) or telaprevir (nu200a=u200a5) immediately (nu200a=u200a3) or after a 4-week lead-in phase (nu200a=u200a4). Immunosuppression included either cyclosporine (nu200a=u200a5) or tacrolimus (nu200a=u200a2). Prior to introducing telaprevir, combined antiretroviral therapy was switched in one patient to prevent drug–drug interactions. Results:At 24 weeks after the end of treatment, sustained virological response was observed in 60% (3/5) of the patients treated with telaprevir; no responders were observed in the boceprevir group. Triple anti-HCV therapy was prematurely discontinued in six patients [treatment failure (nu200a=u200a2), infection (nu200a=u200a2), acute rejection (nu200a=u200a1) and myocardial infarction (nu200a=u200a1)]. Anaemia occurred in all patients, requiring erythropoietin, ribavirin dose reduction and red blood cell transfusions in five patients.Average cyclosporine doses were reduced by 50–84% after telaprevir initiation and by 33% after boceprevir initiation. Tacrolimus doses were reduced by 95% with telaprevir. Conclusion:Our data suggest that in HIV/HCV co-infected patients, triple anti-HCV therapy with telaprevir greatly improved efficacy despite poor tolerability. Significant decreases in cyclosporine or tacrolimus doses are necessary prior to introduction of boceprevir or telaprevir. Close monitoring is essential to prevent drug–drug interactions among antiretroviral therapy, immunosuppressive agents and anti-HCV therapy.

Successful anti-hepatitis C virus therapy with telaprevir in an HIV/hepatitis C virus co-infected patient with a severe recurrence of hepatitis C virus infection on the liver graft.

We report, for the first time, the outcome of anti-hepatitis C virus (HCV) triple therapy with telaprevir in an HIV/HCV co-infected transplanted patient. After liver transplantation, the patient experienced a severe HCV recurrence with fibrosing cholestatic hepatitis, and anti-HCV therapy with pegylated interferon alpha 2a, ribavirin and telaprevir was initiated. A sustained virological response was achieved after 48 weeks of anti-HCV therapy. Drug–drug interactions between antiretroviral therapy, immunosuppressive agents and anti-HCV therapy could be managed.