Human immunodeficiency virus-hepatitis C coinfection: swapping new problems for newer ones

Recent successes in HIV therapy have uncovered other health problems for HI V-infected individuals. Hepatitis C has become an especially significant pr oblem, partly due to its faster progression in an immunocompromised setting . In addition, the higher viral loads in coinfected patients likely result in more efficient perinatal and perhaps even sexual transmission. Therapy h as largely been neglected, despite data suggesting its efficacy in HIV-HCV coinfected patients. Studies of combination interferon and ribavirin studie s are lacking, although underway. A major concern is the potential inactiva tion of certain thymidine analogues by ribavirin. Some antiretroviral thera pies, such as ritonavir, indinavir and nevirapine, may enhance liver toxici ty in coinfected patients and should be avoided if possible. The role of ch ronic low-grade liver function abnormalities remains uncertain and requires further investigation.