Update on hepatitis C treatment in HIV-coinfected patients

Abstract

Hepatitis C virus (HCV) infection has emerged as the main cause of morbidity and mortality in human immunodeficiency virus (HIV)-infected individuals, since the introduction of antiretroviral therapy. Coinfection with both viruses may lead to end-stage liver disease (ESLD), including cirrhosis and hepatocellular carcinoma. HCV infection is altered by HIV presence, although the effect of HCV on HIV infection is still controversial. For this reason, HCV screening is recommended in all HIV-infected persons. The final goal of HCV treatment is to eradicate the virus or, in other words, to eliminate the infection, and this objective is especially important in HIV/HCV-coinfected patients, because they have more severe liver disease, achieve less frequently sustained virologic response on treatment, and have limited access to orthotopic liver transplantation with respect to HCV-monoinfected patients. Combination therapy with pegylated interferon-alpha (pegIFN) and ribavirin (RBV) has become the standard treatment for chronic HCV infection. However, when we compare coinfected with monoinfected patients, this regimen has decreased efficacy, and the rate of adverse effects is higher.