Chronic HCV and HIV Coinfection

Abstract

With the introduction of combination antiretroviral therapy (ART) life expectancy for human immunodeficiency virus type 1 (HIV-1)-infected patients has dramatically improved and liver diseases have emerged as an important factor of non-AIDS morbidity and mortality in HIV patients. Coinfection with the hepatitis C virus (HCV) accounts for the majority of these cases due to similar routes of transmission and high HCV chronification rates. HIV infection enhances HCV fibrosis progression due to several reasons putting these patients in the risk of liver cirrhosis and hepatocellular carcinoma (HCC). HIV infection of the liver, insulin resistance, and antiretroviral drug toxicity are factors that may add up to the classic progression factors such as age, male gender, alcohol intake, steatosis, and necroinflammatory activity. With HCV being a potentially curable disease, current treatment options only lead to response rates of 30–40% in the setting of HIV coinfection. New directly acting agents against HCV are on their way to licensing and will probably lead to advanced cure rates and a consecutive decline of HCV-related complications. However, these new agents lack data and experience in the setting of HIV coinfection. In cirrhotic patients, orthotopic liver transplantation (OLTX) may be the final option. Although promising results have been demonstrated, many centers still refuse OLTX in coinfected patients. Finally, systematic screening for HCC is mandatory in liver cirrhosis to detect patients at earlier stages of the disease. HIV infection has become a manageable chronic disease in the Western world. More aggressive management of HCV in the coinfected population may lead to a further improvement in outcomes for these patients as well.