HIV and hepatitis C co-infection

ABSTRACT

Improved antiretroviral therapy (ART) has reduced HIV-related morbidity and improved survival. Such improvements have led to an increasing contribution of non-HIV related disease to overall morbidity among people with HIV. HIV/HCV co-infection and its associated liver disease is an emerging clinical management issue, particularly in settings of high co-infection prevalence. Treatment for HCV infection in HIV infected individuals is with pegylated interferon and ribavirin therapy. Sustained virological response to therapy is achieved in around 40%, which is 10-20% lower than in HCV monoinfection and therapy may be complicated by issues of drug interactions and significant toxicity. However, greater understanding of baseline factors can contribute to better prediction of treatment outcome, and monitoring of on-treatment virological responses increasingly allows individualisation of therapy. Where possible, treatment of HCV is often advisable before HAART is required to avoid the issues of drug interactions on HCV therapy and the risk of HAART related hepatotoxicity. Early diagnosis of both HIV and HCV-infection is essential to most effectively manage HIV-HCV co-infected individuals. New therapies, including HCV protease and polymerase inhibitors, are in development and may widen therapeutic options for HIV/HCV co-infected individuals in the future.