HIV and Hepatitis C Co-infection: Guideline and Commentary

Douglas G. Fish, MD


January 05, 2011

In This Article

Ongoing Evaluation of Patients in Whom Anti-HCV Treatment Is Deferred

Recommendations. For patients in whom anti-HCV treatment is deferred, clinicians should:

Patients in whom anti-HCV treatment is deferred should receive serial ALT and AST levels every 6 months. However, liver biopsies showing portal or bridging fibrosis, or at least moderate inflammation or necrosis, are the best predictors of eventual cirrhosis. HCV viral load, serum transaminase levels (serum ALT, AST), and HCV genotype do not accurately predict the extent of liver damage, nor do they predict the likelihood of future progressive liver disease.

Significant progression of fibrosis has been observed in HIV/HCV co-infected patients. Up to 2-stage increases via the Ishak fibrosis scoring system (0 to 6) have been observed in liver biopsies that were obtained approximately 3 years apart, even in patients who demonstrated mild liver disease at the initial biopsy.[52] Therefore, repeat biopsy should be performed every 3 to 5 years to assess for disease progression in patients whose initial liver biopsy indicated that treatment was not required.

Key Point

Even in patients who remain free of symptoms and whose liver chemistries remain normal, histologic damage still can occur.


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