De‐“Liver”‐ing HIV/Hepatitis C Virus–Coinfected Patients from Antiretroviral Hepatotoxicity

Abstract

Where data are weak opinions are strong. This statement is applicable to HIV/hepatitis C virus (HCV) coinfection and to the ongoing debate pertaining to the timing and sequence of introduction of HIV and HCV antiviral therapy. Those in favor of combination antiretroviral therapy argue that HIV treatment slows the fibrosis rate reduces HCV RNA levels decreases overall and liver-specific mortality and is more likely to achieve the pretherapeutic objectives of HIV RNA suppression and immunologic restoration than the treatment goals of HCV treatment (i.e. a sustained virological response [SVR]). Those in favor of initial HCV treatment state that combining HIV and HCV antivirals is prohibitively toxic for the patient. The avoidance of didanosine stavudine and zidovudine and the improved adverse effect profile of newer therapeutic regimens have reduced concerns related to concurrent HIV and HCV treatment. Nonetheless this remains a cogent consideration. Another argument frequently put forth is that by first treating and hopefully clearing HCV infection the risk of hepatotoxicity during antiretroviral use will be diminished. The article by Labarga et al. in this issue of the Journal addresses this topic. Assuming that the findings are validated and the limitations addressed in subsequent work these results have the potential to change clinical practice. (excerpt)