Management of hepatitis C in HIV-infected persons

The life expectancy of HIV-infected persons has extended significantly sinc e the introduction of highly active antiretroviral therapies. Although clas sical opportunistic infections are now rarely seen, the toxicity of antiret roviral drugs as well as liver disease caused by hepatitis viruses represen t an increasing cause of morbidity and mortality among HIV-positive persons . Since the rate of hepatitis C virus (HCV) infection is high among HIV car riers (up to 75% among intravenous drug users), HCV/HIV coinfection is wide ly prevalent. Predisposing liver damage favors a higher rate of hepatotoxic ity of antiretroviral drugs, which can limit the benefit of HIV treatment i n some individuals. Overall, severe hepatotoxicity appears in around 10% of subjects who began triple combinations including either protease inhibitor s or non-nucleosides. The progression to cirrhosis seems to occur faster in the setting of HIV infection, and conversely recent data demonstrate that HCV infection can accelerate the progression to AIDS in HIV-positive person s. Although clinicians have been reluctant to treat hepatitis C in HIV-infe cted people, this therapeutic nihilism is unwarranted. The availability of new more successful regimens to treat hepatitis C, in particular using the new pegylated forms of interferon in combination with ribavirin, open new h opes for the care of HIV-HCV-coinfected persons. (C) 2001 Elsevier Science B.V. All rights reserved.