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HCV and HIV co-infection: mechanisms and management

Nature Reviews Gastroenterology & Hepatology volume 11, pages 362–371 (2014)Cite this article

Subjects

Key Points

  • Patients co-infected with HCV and HIV are at increased risk of accelerated disease progression, resulting in higher rates of liver decompensation and death compared with patients monoinfected with HCV

  • HIV accelerates HCV-related fibrosis progression through multiple mechanisms

  • HIV suppression seems to reduce fibrosis progression and decrease rates of hepatic decompensation among co-infected patients

  • Successful HCV therapy is associated with a halting of fibrosis progression and decreased complications from end-stage liver disease, but historical rates of sustained virologic response have been significantly lower among co-infected patients than those for chronic HCV monoinfection

  • Promising data exist for all-oral direct-acting antiviral agents suggesting improved efficacy and tolerability, which supports their use in co-infection

Abstract

HCV and HIV co-infection is associated with accelerated hepatic fibrosis progression and higher rates of liver decompensation and death compared to HCV monoinfection, and liver disease is a leading cause of non-AIDS-related mortality among HIV-infected patients. New insights have revealed multiple mechanisms by which HCV and HIV lead to accelerated disease progression, specifically that HIV infection increases HCV replication, augments HCV-induced hepatic inflammation, increases hepatocyte apoptosis, increases microbial translocation from the gut and leads to an impairment of HCV-specific immune responses. Treatment of HIV with antiretroviral therapy and treatment of HCV have independently been shown to delay the progression of fibrosis and reduce complications from end-stage liver disease among co-infected patients. However, rates of sustained virologic response with PEG-IFN and ribavirin have been significantly inferior among co-infected patients compared with HCV-monoinfected patients, and treatment uptake has remained low given the limited efficacy and tolerability of current HCV regimens. With multiple direct-acting antiviral agents in development to treat HCV, a unique opportunity exists to redefine the treatment paradigm for co-infected patients, which incorporates data on fibrosis stage as well as potential drug interactions with antiretroviral therapy.

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Figure 1: Driving factors underlying liver disease pathogenesis in HCV–HIV co-infection.
Figure 2: Interactions between HCV and HIV in hepatocytes and HSCs that contribute to hepatic fibrogenesis.
Figure 3

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Acknowledgements

The work of the authors is supported by HHS/NIH grants T32DK007191 (J.Y.C.), DK098079 and DA033541 (R.T.C.) and by the Harvard University Center for AIDS Research (HU CFAR NIH/NIAID fund 5P30AI060354-09 to E.R.F.).

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  1. Liver Center and Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, 02114, MA, USA

    Jennifer Y. Chen & Raymond T. Chung

  2. Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, 02114, MA, USA

    Eoin R. Feeney

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  1. Jennifer Y. Chen
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All authors contributed to all aspects of the preparation of this manuscript.

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Correspondence to Raymond T. Chung.

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Competing interests

R.T.C. has acted as a consultant for Abbvie and has received research grant support from Gilead Sciences. J.Y.C. and E.R.F. declare no competing interests.

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Chen, J., Feeney, E. & Chung, R. HCV and HIV co-infection: mechanisms and management. Nat Rev Gastroenterol Hepatol 11, 362–371 (2014). https://doi.org/10.1038/nrgastro.2014.17

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