Hepatitis c virus infection: co-infection with HIV and HBV

Hepatitis C shares common routes of infection with hepatitis B (HBV) and th e human immunodeficiency virus (HIV). It is, therefore, not surprising to f ind that some patients with HCV are co-infected with either HIV and/or HBV. Until recently, the effects of HIV on HCV infection have not been investig ated - sadly patients with HIV died long before their liver disease became problematic. However, the development of successful therapies for HIV have led to dramatic improvements in life expectancy for patients infected with this virus and in these patients, with well controlled HIV, it is becoming clear that hepatitis C may lead to the early onset of advanced liver diseas e. The optimal treatment for these patients is unknown but it seems likely that combination antiviral therapy will be required. The effects of HBV on HCV are also beginning to be investigated and, again, it is clear that co-i nfection leads to more aggressive liver disease with the two viruses intera cting in poorly defined ways to increase the rare of hepatic fibrosis. Mana gement of combined HCV/HBV infection is still under investigation and will probably involve combination therapy.