Should HIV/HCV coinfected patients with severe hepatitis be treated for hepatitis C

Frequent coinfection. One third of HIV-infected patients also carry the hepatitis C virus. Liver disease (fibrosis) in hepatitis C progresses faster and is more severe in HIV patients than in non-coinfected patients. Hepatitis C should be treated. The prolongation of survival of HIV patients since the introduction of highly active antiretroviral treatments (HAART), the faster progression of HCV-related cirrhosis in cases of HIV-HCV coinfection, the increased mortality associated with hepatitis, and the hepatotoxicity of antiretroviral treatments are all arguments in favor of treating hepatitis C in HIV patients. A combination of peginterferon and ribavirin is the treatment of choice for hepatitis C. It has been assessed in patients with HIV-HCV coinfection and showed satisfactory levels of prolonged virologic response. A treatment of 48 weeks is recommended regardless of genotype. Early virologic response is an excellent predictive factor for prolonged response; if no response is observed at 12 weeks, treatment can be stopped. Impact of HAART. Antiretroviral treatment seems to have a positive effect on the course of hepatitis C that exceeds its risk of hepatotoxicity.