Coinfection with the hepatitis C virus and HIV: current aspects

The treatment of coinfection with the hepatitis C virus (HCV) in HIV-infect ed patients was rarely discussed before the era of the HIV protease inhibit ors, since the response to monotherapy with interferon alpha (INF alpha) wa s poor, with a mean prognosis of the HIV disease estimated at around ten ye ars. In the present context, monitoring is reconsidered. The HIV-associated immunosuppression may be responsible fora false negativity of some serolog ic tests for HCV. The HIV-HCV coinfection increases the risk of maternofoet al transmission of HCV. Studies evaluating the influence of the HIV coinfec tion on the natural history of the HCV infection show its deleterious role. The immune restoration obtained with the highly active antiretroviral ther apies is not linked with a decrease of the HCV viral load. The HIV-HCV coin fection is responsible for a threefold increase of the risk of elevation of seric transaminases when an antiretroviral treatment is given. The immune restoration obtained with an antiretroviral treatment may reveal the HCV in fection and favor a rapid aggravation of hepatic histology and evolution to ward cirrhosis. HCV-associated complications may become a major factor of m orbidity and mortality, leading to the need for an anti-hepatitis C treatme nt in HIV-infected patients. The combination of INF alpha and ribavirin see ms to be the best treatment, Its efficacy and tolerability must be evaluate d in HIV-infected patients. Drug interactions are likely to occur, and INF alpha, like ribavirin, may favor CD4 lymphopenia. A new form of INF alpha w ith a prolonged half-life (PEG-INF alpha) seems to be promising. (C) 2000 E ditions scientifiques et medicales Elsevier SAS.