Treatment of Chronic Hepatitis C in Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patients in the Era of Pegylated Interferon and Ribavirin

Norbert Bräu

doi:10.1055/s-2005-864780

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2005; 25(1): 33-51
DOI: 10.1055/s-2005-864780

Published in 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Treatment of Chronic Hepatitis C in Human Immunodeficiency Virus/Hepatitis C Virus-Coinfected Patients in the Era of Pegylated Interferon and Ribavirin

Norbert Bräu¹

¹Divisions of Infectious Diseases and Liver Diseases, Mount Sinai School of Medicine, New York, New York, and Veterans Affairs Medical Center, Bronx, New York

Abstract

ABSTRACT

A significant percentage of human immunodeficiency virus (HIV) -infected individuals are also infected with the hepatitis C virus (HCV). With the much-improved survival of HIV-infected patients through the use of highly active antiretroviral therapy, liver disease caused by coinfection with HCV has emerged as a significant threat to the health and survival of persons with HIV disease. HIV/HCV-coinfected patients with ongoing HIV viremia have a faster rate of HCV-related liver fibrosis progression and a more rapid progression to liver failure or hepatocellular carcinoma than HCV-monoinfected persons. In contrast to the deleterious effect of HIV on HCV-related liver disease, most studies have shown that HCV does not influence progression of HIV infection to AIDS or death. HCV therapy with peginterferon alfa (2a or 2b) plus ribavirin can achieve a sustained viral response in HIV/HCV-coinfected patients of up to 38% in HCV genotype 1 and up to 73% in genotypes 2 and 3. The safety profile is largely similar to therapy in HIV-monoinfected patients, but there is a higher incidence of mitochondrial toxicity in patients taking didanosine or stavudine and of anemia in patients taking zidovudine. There is no proven anti-HCV therapy for HIV/HCV-coinfected patients with end-stage liver disease (ESLD). Liver transplantation is being investigated as a potential therapeutic option for HIV-infected individuals with ESLD, and initial reports are encouraging. Given that pegylated interferon and ribavirin have been shown to be safe and effective for HIV/HCV coinfection as well as HCV monoinfection, all HIV/HCV-coinfected patients should be evaluated for therapy.

KEYWORDS

Hepatitis C - HIV - coinfection - therapy - epidemiology

Full Text

References

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Norbert BräuM.D. M.B.A.

Mount Sinai School of Medicine, Bronx Veterans Affairs Medical Center, Infectious Disease Section (111F)

130 West Kingsbridge Road, Bronx, NY 10468

Email: norbert.brau@med.va.gov