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Review
. 2015 Feb 12;4(1):1-12.
doi: 10.5501/wjv.v4.i1.1.

Treatment of chronic hepatitis C in patients with HIV/HCV coinfection

Nicola Coppola  1 , Salvatore Martini  1 , Mariantonietta Pisaturo  1 , Caterina Sagnelli  1 , Pietro Filippini  1 , Evangelista Sagnelli  1
Affiliations
Review

Treatment of chronic hepatitis C in patients with HIV/HCV coinfection

Nicola Coppola et al. World J Virol. .

Abstract

Hepatitis C virus (HCV) infection is one of the most frequent causes of comorbidity and mortality in the human immunodeficiency virus (HIV) population, and liver-related mortality is now the second highest cause of death in HIV-positive patients, so HCV infection should be countered with adequate antiviral therapy. In 2011 began the era of directly acting antivirals (DAAs) and the HCV NS3/4A protease inhibitors telaprevir and boceprevir were approved to treat HCV-genotype-1 infection, each one in combination with pegylated interferon alfa (Peg-IFN) + ribavirin (RBV). The addition of the first generation DAAs, strongly improved the efficacy of antiviral therapy in patients with HCV-genotype 1, both for the HCV-monoinfected and HIV/HCV coinfected, and the poor response to Peg-IFN + RBV in HCV/HIV coinfection was enhanced. These treatments showed higher rates of sustained virological response than Peg-IFN + RBV but reduced tolerability and adherence due to the high pill burden and the several pharmacokinetic interactions between HCV NS3/4A protease inhibitors and antiretroviral drugs. Then in 2013 a new wave of DAAs arrived, characterized by high efficacy, good tolerability, a low pill burden and shortened treatment duration. The second and third generation DAAs also comprised IFN-free regimens, which in small recent trials on HIV-positive patients have shown comforting preliminary results in terms of efficacy, tolerability and adherence.

Keywords: Anti-hepatitis C virus treatment; Chronic hepatitis C; Directly acting antivirals; HIV/HCV coinfection; Hepatitis C virus infection; Human immunode-ficiency virus infection.

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Figures

Figure 1
Figure 1
Factors influencing treatment decision for chronic hepatitis C in human immunodeficiency virus/hepatitis C virus-1 coinfection: treat or defer treatment. HIV: Human immunodeficiency virus; IFN: Interferon.
Figure 2
Figure 2
Treatment of chronic hepatitis C, hepatitis C virus-genotype 1 or 4, in patients with Human immunodeficiency virus/hepatitis C virus coinfection. RVR: Rapid virological response; IFN: Interferon. HCV: Hepatitis C virus.
Figure 3
Figure 3
Treatment of chronic hepatitis C, HCV-genotype 2 or 3, in patients with human immunodeficiency virus/hepatitis C virus coinfection. RVR: Rapid virological response; IFN: Interferon.
See this image and copyright information in PMC

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