Hepatitis C in patients with human immunodeficiency virus infection - Diagnosis, natural history, meta-analysis of sexual and vertical transmission, and therapeutic issues
M. Bonacini et M. Puoti, Hepatitis C in patients with human immunodeficiency virus infection - Diagnosis, natural history, meta-analysis of sexual and vertical transmission, and therapeutic issues, ARCH IN MED, 160(22), 2000, pp. 3365-3373
Citations number
130
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Hepatitis C (HCV) infection occurs in as many as 33% of the patients with h
uman immunodeficiency virus (HIV) infection. In view of their improved surv
ival, liver disease will become more clinically significant in patients coi
nfected with HIV/HCV. Several studies in patients with hemophilia have show
n that coinfected patients develop earlier and more severe liver disease, i
ncluding hepatocellular carcinoma. In nonhemophilic cohorts, lower CD4 coun
ts are associated with an increased prevalence of cirrhosis. However, HCV i
nfection does not seem to alter the natural history of HIV infection in mos
t cases. Human immunodeficiency virus coinfection in pregnant women increas
es the risk of perinatal HCV transmission 2-fold, with more than 25% of occ
urrences involving transmission of both viruses: cesarean delivery signific
antly decreases this risk. The expanded use of highly active antiretroviral
therapy may lead to further improvement in morbidity and mortality from HI
V infection. Thus, the management of coexistent HCV liver disease will need
to be formulated. We suggest that alcohol be disallowed. Interferon and ri
bavirin in combination are likely to become the therapy of choice, particul
arly in coinfected patients with higher CD4 counts, lower HCV viremia, and
non-1 genotype. During treatment, complete blood cell counts need to be clo
sely monitored. Future controlled trials will determine the efficacy and sa
fety of long-acting interferon preparations. Administration of highly activ
e antiretroviral therapy, with the intent to prevent decreases in CD4 count
s, seems crucial in stemming liver disease progression. However, some drugs
have clear-cut hepatotoxic potential and patients with known liver disease
should be closely monitored.