Evaluation and management of the patient co-infected with human immunodeficiency virus and hepatitis C.

Abstract

The emerging presence of hepatitis C viral (HCV) infection in the United States has been the focus of much attention among health care providers and the general population. Among patients infected with human immunodeficiency virus (HIV), there has been a dramatic increase in hepatitis C disease. During the 1980s and early 1990s, hepatitis C was viewed as a disease for which little could be done, both because of ineffective treatment and the severity and lack of adequate treatments for acquired immune deficiency syndrome (AIDS) itself. Treatment with interferon had poor effect on hepatitis C in the co-infected population, especially for those with advanced immunosuppression. The regimen was difficult to tolerate even with dose reductions. With the advent of highly active antiretroviral therapy (HAART) and effective treatment and prophylaxis for opportunistic infections, a substantial portion of HIV-infected patients are living long enough to have their health compromised by hepatic failure or hepatocellular carcinoma owing to hepatitis C, rather than by AIDS-related illness. New treatments are available for hepatitis C, with preliminary research yielding promising results. The role of these medications in managing HIV/HCV co-infection is currently under study, with implications for many. Health care providers are increasingly faced with the challenges of caring for people infected with the hepatitis C virus, and the growing number of individuals co-infected with hepatitis C and HIV. The purpose of this article is to provide an overview of hepatitis C, especially in the presence of HIV infection, and to detail the recognition and management of the care of this emerging population.