HIV coinfection with hepatitis C virus: evolving epidemiology and treatment paradigms

Abstract

Chronic hepatitis C virus (HCV) infection has become a major threat to the survival of human immunodeficiency virus (HIV)-infected persons in areas where antiretroviral therapy is available. In coinfection, viral eradication has been difficult to attain, and HCV therapy is underused. Novel therapies may be particularly beneficial for this population, yet studies lag behind those for HCV monoinfection. Increasingly, incident HCV among HIV-infected men who have sex with men is associated with sexual risk behavior further research should be performed to refine understanding of the causal mechanism of this association. The phenomenon of aggressive hepatic fibrogenesis when HIV infection precedes HCV acquisition requires longer-term observation to ensure optimal timing of HCV therapy. Medical management in coinfection will be improved by enhancing HCV detection, with annual serologic testing, screening with HCV RNA to detect acute infection, and HIV testing of HCV-infected individuals; by addressing HCV earlier in coinfected persons; and by universal consideration for HCV therapy. HCV drug trials in individuals coinfected with HIV should be expedited. HIV/HCV coinfection remains a growing and evolving epidemic; new developments in therapeutics and improved care models offer promise.

Figure 1.

Biobehavioral factors associated with increased hepatitis C virus transmission among HIV-infected men who have sex with men. ^aDefined as the practice of engaging in unprotected sex with individuals who have the same human immunodeficiency virus serostatus.

Figure 2.

Hepatitis C virus (HCV) screening, HCV evaluation, and ongoing care in HIV/HCV coinfection. Information is adapted from [44]. ^aGenetic variations in the gene encoding interleukin 28B, located on chromosome 19, strongly correlate with spontaneous and treatment-induced HCV clearance in coinfection. Appendix B, Table 7 [44a]. Abbreviations: Ab, antibody; ALT, alanine aminotransferase; ANC, absolute neutrophil count; AP, alkaline phosphatase; AST, aspartate aminotransferase; CPT, Child-Pugh-Turcotte; Cr, creatinine; ddI, didanosine; D4T, stavudine; EGD, esophagogastroduodenoscopy; HCC, hepatocellular carcinoma; HCT, hematocrit; Hg, hemoglobin; IL-28B, interleukin 28B; INR, international normalized ratio; MELD, model for end-stage liver disease; PE, physical examination; PT, prothrombin time; RUQ, right upper quadrant.

Figure 3.

Modifiable barriers and facilitators of treatment for hepatitis C virus (HCV) infection in individuals coinfected with human immunodeficiency virus (HIV) and HCV. Abbreviations: HCV, hepatitis C virus; HIV, human immunodeficiency virus; SVR, sustained virologic response.