Update on the Management of HIV and Hepatitis C Virus Coinfection

Marion G. Peters, MD; Karly Louie, BS; Norah Terrault, MD

Disclosures

Medscape HIV/AIDS eJournal. 2002;8(1) 

In This Article

Introduction

The management of HIV and hepatitis C virus (HCV) coinfection is evolving rapidly. Coinfected patients present a special challenge in the era of highly active antiretroviral therapy (HAART) because concomitant hepatotoxicity, steatosis, and cytopenias may render patients ineligible for standard therapies for HCV. Elimination of HCV is considered the "gold standard" for sustained virologic response; other important goals of anti-HCV therapy are to improve symptoms, ameliorate inflammation, decrease or reverse fibrosis, and prevent the development of hepatocellular carcinoma and liver failure.

Among HIV-uninfected, HCV-infected individuals who are treated, sustained virologic responders usually experience normalized serum aminotransferases (ALT) and improved fibrosis on liver biopsy. However, biochemical responders (those who do not lose HCV RNA from serum but normalize serum aminotransferases) and nonresponders to current therapies may also obtain an improvement in liver histology. Thus, when evaluating the "response" to therapies in HIV/HCV-coinfected individuals, one should assess both virologic and histologic responses.

This review will explore recent developments of practical relevance to the management of coinfected patients, and will highlight recent data presented at the annual meeting of the American Association for the Study of Liver Diseases (AASLD) in Dallas, Texas, in November 2001.

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