Evaluation and Treatment of Hepatitis C in Patients With Coexisting HIV Infection

Scott D. Parker, MD

In This Article

Concluding Remarks

Therapy for HCV infection can interrupt the progression to advanced liver disease and should be offered to selected patients with coexisting HIV infection. Treatment is relatively well tolerated, but there is the potential for serious interactions between HCV therapy and agents used for antiretroviral therapy; there is also a significant risk of hepatic decompensation in patients with cirrhosis and laboratory markers of advanced liver disease. Most coinfected patients in the United States have genotype 1 disease with high viral loads; the virologic success rate of HCV therapy in this group is markedly reduced when compared with the HCV-monoinfected patient population. With the pegylation of interferon combined with more aggressive dosing of ribavirin, we have likely reached the maximum potential of the agents currently used in the treatment of hepatitis C. For the future, the development of potent inhibitors of the HCV protease or polymerase represents the next generation in HCV therapy. These agents have the potential to eradicate HCV in a substantial number of patients and will be treatment options for significant numbers of patients who have failed to achieve an SVR with current therapy.


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