New paradigms in the management of HIV and hepatitis C virus coinfection

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New paradigms in the management of HIV and hepatitis C virus coinfection.

Current Opinion in Infectious Diseases. 18(6):550-560, December 2005.

Soriano, a; -Carbonero, Luz a; Maida, Ivana a;

-Samaniego, b; Nunez, Marina a

Abstract:

Purpose of review: Chronic hepatitis C virus infection is currently one of

the leading causes of morbidity and mortality in HIV-infected individuals,

mainly in hemophiliacs and intravenous drug users. The bidirectional

interferences between hepatitis C virus and HIV have clinical consequences

and complicate the management of coinfected individuals.

Recent findings: There is an increased rate of liver complications among

coinfected patients due to the decrease in opportunistic infections

resulting from the use of potent antiretroviral therapy and accelerated

progression to liver cirrhosis in the HIV setting. Conversely, the risk of

hepatotoxicity of antiretrovirals is higher in the presence of chronic

hepatitis C. While the standard therapy for hepatitis C in HIV is the

combination of pegylated interferon plus ribavirin, overall treatment

responses are lower in HIV-coinfected than in hepatitis C virus-monoinfected

patients. Moreover, interactions between ribavirin and HIV drugs (i.e.

didanosine, zidovudine) are associated with higher risks of side effects.

Summary: Given the accelerated progression to end-stage liver disease in

coinfected patients, treatment of hepatitis C should be a priority. While

hepatitis C therapy should not be denied in the absence of contraindication,

it should be re-assessed at week 12 and therapy continued only in patients

showing more than 2 log drops in viremia, to avoid side effects. Most recent

data suggest that adequate selection of candidates, expert management of

side effects, and prescription of appropriate ribavirin doses (in genotypes

1-4) and extending treatment (in genotypes 2-3) all might allow response

rates in coinfected patients to approach those seen in hepatitis C

virus-monoinfected individuals.

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