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HIV-AIDS

Treatment of Hepatitis C in HIV-Coinfected Patients

Associate Professor, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta; Clinical Pharmacist, HIV, Capital Health Region, Edmonton, Alberta, Canada

Stephen D Shafran, MD FRCPC

Professor, Division of Infectious Diseases, Department of Medicine, University of Alberta

Reprints: Dr. Hughes, Faculty of Pharmacy and Pharmaceutical Sciences, 3126 Dentistry/Pharmacy Centre, University of Alberta, Edmonton, AB T6G 2N8, Canada, fax 780/492-1217, christine.hughes{at}ualberta.ca

OBJECTIVE: To review the current management of hepatitis C virus (HCV) in persons coinfected with HIV.

DATA SOURCES: A MEDLINE search (1966–February 2006) was conducted, using key words such as HIV, human immunodeficiency virus, hepatitis C, interferon, pegylated interferon, and therapy. Article bibliographies and conference abstracts were also reviewed to identify relevant studies.

STUDY SELECTION AND DATA EXTRACTION: Studies that examined HCV treatment in individuals coinfected with HIV and articles that focused on HCV/HIV coinfection were considered for this review.

DATA SYNTHESIS: Coinfection with HIV leads to a more rapid and severe course of HCV-related liver disease. Treatment of HCV with pegylated interferon (PEG-IFN) and ribavirin therapy is relatively well tolerated in individuals coinfected with HIV, with overall sustained virologic response (SVR) rates of 27–40%. High relapse rates and poor response in HCV-genotype 1 contribute to the lower SVR in coinfected individuals compared with HCV monoinfection. Treatment of HCV is more complicated in HIV-infected persons due to increased risk of myelosuppression, drug interactions, hepatotoxicity of antiretroviral therapy, and the relative contraindication to interferon therapy in advanced HIV disease. Current guidelines recommend that all HIV-positive patients with chronic HCV infection be considered as treatment candidates for anti-HCV therapy due to the higher risk of liver disease progression. Further studies are needed, however, to define the appropriate dose and duration of therapy in HCV/HIV-coinfected individuals.

CONCLUSIONS: Response to treatment with PEG-IFN and ribavirin is poorer in patients coinfected with HCV/HIV than in those infected with HCV alone. The benefits of anti-HCV therapy, including viral eradication, need to be weighed against the risks of adverse effects and drug–drug interactions between anti-HCV and antiretroviral medications.

Key Words: hepatitis C, human immunodeficiency virus, interferon

Published Online, February 28, 2006. www.theannals.com, DOI 10.1345/aph.1G427

THIS ARTICLE IS APPROVED FOR CONTINUING EDUCATION CREDIT
ACPE UNIVERSAL PROGRAM NUMBER: 407-000-06-006-H02

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