Managing HCV/HIV Coinfection

According to national estimates, about 15% to 30% of people with HIV in the United States are coinfected with hepatitis C virus (HCV). Reports also show that as many as 90% of those with HIV secondary to injection drug use are coinfected with HCV. The rate of progression to cirrhosis for people coinfected with HCV/HIV is about three times higher than the rate for people who only have HCV infection. This accelerated rate is magnified in patients with low CD4 counts. “HCV/HIV coinfection can result in chronic liver diseases, most notably cirrhosis but also liver cancer,” explains David L. Thomas, MD, MPH. “The coinfection can lead to significant morbidity and mortality.” Compounding the problem is that chronic HCV infection can complicate HIV treatment because it increases the frequency of antiretroviral therapy (ART)-associated hepatotoxicity. “The accelerated rate of liver disease progression associated with HCV/HIV coinfection is an important factor to consider.” Several clinical investigations have shown that the prognosis is poorer for HCV/HIV coinfected persons than for persons with just HIV in the era of combination ART. It is unknown if ART reduces morbidity and mortality from untreated HCV. What is known is that ART does not reduce liver mortality enough. In some centers, liver failure is one of the leading causes of death in HIV-infected persons. As a result, treatments for HCV/HIV coinfection must be individualized based on several important patient factors (Table 1). Managing Coinfection & Using ART Guidelines from the U.S. Department of Health and Human Services (HHS) indicate that HIV-infected patients should be screened for HCV infection with immunoassays prior to initiation of ART. Patients with...