Liver damage and kinetics of hepatitis C virus and human immunodeficiency virus replication during the early phases of combination antiretroviral treatment

In order to assess the relationship between human immunodeficiency virus (H IV) RNA, hepatitis C virus (HCV) RNA, CD4, CD8, and liver enzymes during co mbination antiretroviral therapy, these parameters were measured in 12 HIV- HCV-coinfected patients (who were naive for antiretrovirals) on the day bef ore and 3, 7, 14, 28, 56, and 84 days after initiating the following treatm ents: stavudine and lamivudine in all patients, indinavir in 6 patients, an d nevirapine in 6 patients. HIV RNA declined rapidly, CD4 cells increased s lowly, and CD8 cells and liver enzymes were stable. HCV RNA showed a transi ent significant increase at days 14 and 21 (7.33 +/- 0.16 [mean +/- SE] and 7.29 +/- 0.2 log copies/mL vs. 7 +/- 0.2 log copies/mL at baseline; P<.05) . These changes were similar in both treatment groups. A 2-fold alanine ami notransferase increase was observed in 4 of 12 patients; 4 of 4 patients sh owed increased HCV RNA. The relationship between HCV RNA increase and HIV R NA decrease indicates virus-virus interference. An HCV RNA increase may cau se significant liver damage only in a minority of patients.