Management of hepatitis C virus coinfection in HIV-infected persons

Approximately 300,000 patients in the United States are coinfected with HIV and hepatitis C virus (HCV). More rapid progression of HCV-related liver disease is seen in coinfected patients than in HCV-monoinfected patients. Since the introduction of potent antiretroviral therapy, liver disease has become a leading cause of death in HIV-infected patients. Therefore, more aggressive management of HCV-related liver disease is essential in HIV-positive patients. Recently, several trials have established the superiority of pegylated interferon alfa in combination with ribavirin to standard interferon with ribavirin for treatment of HCV infection in HIV-HCV-coinfected patients. Sustained virologic response (SVR) rates were only 14% to 29% in genotype 1 and 43% to 73% in genotype 2 and 3 HCV with 48 weeks of combination therapy. Absence of an early virologic response determined at 12 weeks can limit treatment exposure in patients destined not to achieve an SVR. The risk of interactions between drugs used to treat hepatitis C and those for HIV, such as between ribavirin and didanosine, needs to be considered before initiating treatment in HIV-HCV-coinfected patients.