HCV and HIV co-infection: mechanisms and management

Abstract

HCV and HIV co-infection is associated with accelerated hepatic fibrosis progression and higher rates of liver decompensation and death compared to HCV monoinfection, and liver disease is a leading cause of non-AIDS related mortality among HIV-infected patients. New insights have revealed multiple mechanisms by which HCV and HIV lead to accelerated disease progression, specifically that HIV infection increases HCV replication, augments HCV-induced hepatic inflammation, increases hepatocyte apoptosis, increases microbial translocation from the gut, and leads to an impairment of HCV-specific immune responses. Treatment of HIV with antiretroviral therapy and treatment of HCV have independently been shown to delay the progression of fibrosis and reduce complications from end-stage liver disease among co-infected patients. However, rates of sustained virologic response with PEG-IFN and ribavirin have been significantly inferior among co-infected patients compared to HCV monoinfected patients, and treatment uptake has remained low given the limited efficacy and tolerability of current HCV regimens. With multiple direct acting antivirals in development to treat HCV, a unique opportunity exists to redefine the treatment paradigm for co-infected patients, which incorporates data on fibrosis stage as well as potential drug interactions with antiretroviral therapy.

Pharmacologic Considerations in the Treatment of Hepatitis C Virus in Persons With HIV

“…HIV accelerates the progression of HCV disease. Individuals with HIV coinfection have higher HCV RNA, a more rapid progression of fibrosis, and an increased frequency of liver decompensation and death [3][4][5][6]. Due to the increased risks associated with HIV coinfection, treatment guidelines consider this patient population a "high priority" for HCV treatment [7,8].…”

Trattamento con antivirali ad azione diretta (DAAs) in pazienti monoinfetti e coinfetti HIV-HCV: l’esperienza del Progetto SCOLTA

“…La contemporanea presenza del virus HIV favorisce una più rapida progressione del danno epatico verso cirrosi. La diminuzione della risposta immune, le possibili tossicità farmacologiche da antiretrovirali sono tra i principali fattori correlati ad HIV che favoriscono l'evoluzione dell'epatopatia (10). In questo contesto, l'eradicazione dell'epatite C risulta un obiettivo di primaria importanza, rappresentando uno strumento in grado di ridurre la mortalità per cause epatiche ed extra epatiche (11).…”

Chronic Viral Hepatitis in Human Immunodeficiency Virus-infected Patients

“…HCV is now a curable disease with the development of DAA agents (22). For a long time, pegylated interferon-alpha and ribavirin were used in patients with HIV with suboptimal response rates (23).…”