HIV and HCV Coinfection: Where Are We in 2010?

Abstract

The epidemics of hepatitis C virus (HCV) and HIV are major causes of morbidity and mortality worldwide; the 33 million individuals who are coinfected with HCV and HIV face an increased risk of complications and death from liver disease in light of the accelerated progression of hepatitis C to fibrosis and cirrhosis in HIV coinfection. The mechanisms by which HIV accelerates the progression of HCV are thought to be related to alterations in the immunologic milieu, which collectively act to promote fibrogenesis. The progression of liver disease is in large part related to immunodeficiency, and, as with monoinfected individuals, optimal management of HIV infection with HAART may be important for prevention of hepatic morbidity. Treatment of HCV with pegylated interferon and ribavirin should be considered in eligible coinfected persons. Clinical trials in this population demonstrate sustained virologic response rates ranging from 17% to 35% in genotypes 1 and 4 and 44% to 73% in genotypes 2 and 3. However, given these limited response rates and high rates of intolerability, the impending introduction of directly acting antivirals against HCV holds particular promise for interruption of the insidious natural history of liver disease in HIV coinfected persons.