Management of hepatitis C viral infection in HIV-positive patients taking antiretroviral treatment

Context: The prevalence of hepatitis C virus (HCV) infection in patients infected by the human immunodeficiency virus (HIV) varies from 10 to 30%, depending on the mode of contamination, and reaches about 80% in intravenous drug users and hemophiliacs. The two viral infections can be treated simultaneously or, on the contrary, one may be given priority depending on the respective pathological or viral situations. I Management of coinfections: HCV infection does not appear to affect the natural course of HIV infection. Inversely, HIV infection aggravates HCV infection by amplifying HCV replication. This leads to a risk of more severe liver disease and a more rapid progression to cirrhosis. Mortality in HIV-infected patients is higher. This points to the importance of early diagnosis and treatment aimed at avoiding progression to potentially severe liver disease. The impact of highly effective anti-HIV tritherapy regimens, particularly restoration of immune competence, and of drug-induced hepatitis on the natural history of HCV infection should be taken into consideration when making management decisions concerning implementation of antiretroviral or anti-hepatitis C treatments. Perspectives: The long-term efficacy of alpha-interferon given in a single-drug regimen has been mediocre. New perspectives have appeared with the development of new treatments, particularly the ribavirin-alpha-interferon combination or the development of delayed-release alpha-interferon.