Treatment of Patients Infected with both HIV and HCV

There are many individuals with both HIV and HCV infection. A total of 130 million people around the world estimated to be infected with HCV and 40 million with HIV. Shared routes of transmission mean that coinfection is common affecting an estimated 4-5 million individuals around the world. In the developing world, infection with HCV is frequently associated with unsafe injection practices and unscreened blood transfusions. An increased incidence of sexual transmission of HCV in HIV positive patients has been reported in heterosexual couples and in MSM.
Following the advent of highly active antiretroviral therapy (HAART) for the treatment of HIV, liver disease is emerging as a major cause of death and has overtaken AIDS defining illnesses in some patient populations. More rapid progression of HCV-related liver disease is seen in HIV positive individuals, HCV treatment success rates are lower in patients with HIV infection and there are complex issues with interactions of antiviral medication, interferon (IFN) and ribavirin.
Many ARV agents are potentially hepatotoxic and there have been concerns that there may be an increased risk of hepatotoxic reactions in those with hepatitis C.
HIV positive patients with acute hepatitis C may wish to elect for prompt treatment with IFN and ribavirin in view of a higher likelihood of response during early infection. Patients who are considered eligible for treatment may require HAART or antidepressant medication prior to starting IFN and this may result in a longer diagnosis treatment time period. Depression is a significant concern when treating such patients as it reaches a high prevalence in patients with dual infection (up to 42%). Treatment of HIV positive individuals superinfected acutely with HCV may achieve higher SVR rates with PEG IFN and ribavirin than those with chronic infection. However, a significant proportion of patients does not respond or qualify for treatment.

(J Viral Hepat. 2008;15(11):773-781)