Hepatitis C in HIV-infected individuals: cure and control, right now

Abstract

For persons living with HIV, hepatitis C is a major public health problem that must be controlled and could be eliminated. The challenge arises because the hepatitis C virus (HCV) is prevalent among HIV-infected persons in most parts of the world, because HIV worsens all HCV outcomes, and because HCV may add additional individual economic and psychosocial complications to HIV disease. Despite the major benefits of antiretroviral therapy on HIV outcomes, antiretroviral therapy is not sufficient to halt the complications of HCV. Nonetheless, HCV can be controlled at all stages, including prevention of infection and cure. Thus, HCV is an eradicable disease. There are significant inequalities worldwide in HCV control that could markedly constrain the impact of these measures.

Figure 1

HCV co-infection is common among HIV-infected injecting drug users.

Figure 2

Incidence of HIV and HCV among Baltimore IDUs. Adapted from Villano et al [46].

Figure 3

HIV infection adversely affects all stages of hepatitis C.

Figure 4

Markedly lower survival for HIV/HCV-coinfected persons in Denmark: 2000-2005. Reproduced from Lohse et al [32].

Figure 5

The disparity between potential HCV treatment efficacy and projected HCV treatment effectiveness. Adapted from Thomas DL [47].