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New paradigms in the management of hepatitis C virus co-infections

Nature Clinical Practice Gastroenterology & Hepatology volume 4, pages S10–S16 (2007)Cite this article

Abstract

Liver disease has emerged as a major contributor to morbidity and mortality in patients with HIV infection. Hepatitis C virus (HCV) infection is a key element in the etiology of liver-associated injury in this population. Increased rates of fibrotic progression have been described and are mediated by alcohol use, the severity of immunosuppression, the use of antiretroviral therapy, and other factors. Large clinical trials have demonstrated the efficacy of treatment with pegylated interferon plus ribavirin and highlighted issues related to management of patients with HIV/HCV co-infection. Although treatment for HCV infection in this group remains a challenge, achievement of a sustained virologic response is feasible in approximately 35% of patients. Treatment must be individualized and attention must be paid to the potential for drug–drug interactions.

Key Points

  • Re-emergence of high-risk behaviors is leading to resurgence of HIV infection and co-infections, including hepatitis C virus (HCV)

  • End-stage liver disease exceeds AIDS as the leading cause of death among patients with HIV/HCV co-infection

  • Treatment with pegylated interferon plus ribavirin is superior to standard therapy with interferon plus ribavirin in patients with HIV/HCV co-infection

  • Selection of patients for treatment and the evaluation of antiretroviral regimens are crucial in this population

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Figure 1: Prevalence of antibody for the hepatitis C virus in HIV-infected patients
Figure 2: Virologic response rates to pegylated interferon plus ribavirin in patients co-infected with the hepatitis C virus and HIV
Figure 3: Early virologic response as a predictor of SVR

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Authors and Affiliations

  1. KE Sherman is Gould Professor of Medicine and Director of the Division of Digestive Diseases at the University of Cincinnati School of Medicine, Cincinnati, OH, USA.,

    Kenneth E Sherman

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  1. Kenneth E Sherman
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Correspondence to Kenneth E Sherman.

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Competing interests

Kenneth E Sherman receives research support from Abbott, Intermune, Idenix, Roche, SciClone Pharmaceuticals, and Schering-Plough. He belongs to the speaker bureau of Roche, Schering-Plough and SciClone Pharmaceuticals, and is a consultant for these three companies and BMS.

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Sherman, K. New paradigms in the management of hepatitis C virus co-infections. Nat Rev Gastroenterol Hepatol 4 (Suppl 1), S10–S16 (2007). https://doi.org/10.1038/ncpgasthep0692

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