Care of Patients With Hepatitis C and HIV Co-Infection

Vincent Soriano; Massimo Puoti; Mark Sulkowski; Stefan Mauss; Patrice Cacoub; Antonietta Cargnel; Douglas Dieterich; Angelos Hatzakis; Jurgen Rockstroh


AIDS. 2004;18(1) 

In This Article

Influence of Hepatitis C Virus Infection on HIV Disease Progression and Response to Antiretroviral Therapy


The state of permanent immune activation provided by chronic HCV infection might act deleteriously in HIV-positive individuals, favouring HIV transcription within infected cells and the more rapid destruction of CD4 T lymphocytes.[7] On the other hand, the immune recovery seen after beginning effective antiretroviral therapy could be partly blunted in individuals with HCV infection as a result of similar mechanisms, or through the infection of immune cells by HCV itself.[8,9]

Clinical studies that have examined whether there is an influence of HCV on HIV disease progression show conflicting results. Whereas some have demonstrated an association between HCV infection and faster HIV disease progression, others have not.[10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30] In the Swiss cohort,[20] HIV-positive individuals with HCV infection progressed faster to AIDS and death than those who were HCV negative. Some of the available data support a direct negative impact of HCV on HIV disease progression, although to a slight extent. In addition, HCV may negatively influence HIV disease in indirect ways, such as making the discontinuation of antiretroviral treatment more frequent because of an increased risk of liver toxicity.[4,31]

Panel Recommendation

HCV might act as a co-factor for HIV disease progression by several mechanisms. First, unspecific immune stimulation driven by chronic HCV infection might enhance HIV replication. Second, the infection of immune cells by HCV could favour CD4 T-cell depletion and partly blunt the immune recovery that follows successful antiretroviral therapy. Third, HCV could compromise the benefit of antiretroviral drugs as a result of a higher incidence of liver toxicity and treatment discontinuation. However, a negative impact of HCV on HIV disease progression has not been recognized in some large clinical-epidemiological studies. SCORE: C.II


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