HIV and hepatitis C co-infection

Chronic hepatitis C virus (HCV) infection is currently one of the most clinically relevant co-morbidities in the HIV-infected population. Overall, one third of HIV-infected individuals in Europe are HCV co-infected. The progression of chronic HCV infection to liver cirrhosis with subsequent risk for liver decompensation and hepatocellular carcinoma is substantially accelerated in HIV/HCV co-infected compared to HCV mono-infected individuals, particularly with advanced levels of immunodeficiency. Indeed, immune reconstitution under HAART has been associated with slowing down fibrosis progression in HIV/HCV co-infected individuals. Therefore HAART initiation is recommended earlier in HCV co-infected patients. Moreover, the sequelae of chronic hepatitis C infection can be stopped by successful treatment with pegylated interferon and ribavirin combination therapy so that every HIV/HCV co-infected patient should be evaluated for possible HCV treatment. In this review we summarize the current epidemiology, natural course of HCV in HIV co-infection and current guidelines for management of chronic hepatitis C infection in HIV co-infected patients. © Georg Thieme Verlag KG Stuttgart.