Therapy of chronic hepatitis C in the setting of HIV co-infection

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infections are major health problems world-wide. As both viruses partially share routes of transmission, co-infection is com- mon. This is especially the case in patients infected through intra- venous drug use. It has been shown that HIV accelerates HCV progression to cirrhosis. The influence of HCV infection on the natural history of HIV disease remains highly controversial. It is also known that HCV co-infection increases the risk of hepato- toxicity of Highly Active Antiretroviral Therapy (HAART). These considerations as well as the improved survival of HIV patients due to HAART leads to increasing numbers of patients undergo- ing assessment and treatment of HCV infection. HCV treatment should be considered in stable HIV disease. Recent data indicate that HCV treatment schedules should be similar in co-infected and HCV mono-infected individuals, with pegylated interferon com- bined with ribavirin. For all treatment regimens published, co- infected patients had a lower sustained viral response rate com- pared to HCV mono-infected patients. Similar predictive factors determine the success rate. The effect of prolonging therapy to 12 months in genotype 2/3 and to 18 months in early viral respon- ders with genotypes 1/4 needs to be assessed in further studies. (Acta gastroenterol. belg., 2005, 68, 86-91).