A changing paradigm: management and treatment of the HCV/HIV-co-infected patient

Abstract

Hepatitis C virus (HCV) treatment in HIV/HCV co-infected individuals has renewed relevance given the ongoing opioid crisis and rise of new HIV and HCV infections associated with injection drug use. Patients co-infected with HIV and HCV demonstrate increased rates of hepatic fibrosis, progression to liver failure, and liver-related mortality. HIV co-infection does not impact outcomes of current HCV treatments, and patients should be treated the same as HCV mono-infected persons, though attention to drug:drug interactions is required. In this review, we discuss the mechanisms mediating injury to the liver in HIV mono-infection and HIV/HCV co-infection, and present the landmark trials of HCV treatment in HIV-infected individuals.

Keywords: Co-infection; DAA; Drug–drug interactions; HCV; HIV.

Fig. 1

Causes of liver disease in HIV infection. HCV hepatitis C virus, HEV hepatitis E virus, HBV hepatitis B virus, HDV hepatitis D virus, HAV hepatitis A virus, EtOH alcohol, IDU IV drug use, NRTI nucleoside reverse transcriptase inhibitor, NNRTI non-nucleoside reverse transcriptase inhibitor, PI protease inhibitor

Fig. 2

Liver-mediated injury of HIV/HCV co-infection. HIV human immunodeficiency virus, HCV hepatitis C virus, IP-10 interferon-gamma induced protein 10, IL-1β interleukin-1β, TGF-β transforming growth factor-β, TNF-α tumor necrosis factor-α

Fig. 3

Change in SVR with evolution of HCV treatment options across ART eras. HCV Hepatitis C virus, IFN interferon, PEG pegylated, RBV ribavirin, FDC fixed-dose combination, DAA direct-acting antiviral, *SVR 40% [75], **SVR 60–80% [76], ***SVR 80–100% [54, 55, 57, 60, 62, 74]