Update of HCV in HIV-Coinfected Patients: Immunobiology and Current Treatment Options
Affiliation: nternal Medicine Department, Hospital Garcia de Orta, Almada, Portugal.
Chronic hepatitis C virus (HCV) coinfects nearly 25% of HIV patients and it has been associated with more
rapid progression of liver fibrosis, leading to cirrhosis, end-stage liver disease and hepatocellular carcinoma.
Emerging data support multiple derangements attending HIV coinfection, including increases in profibrogenic cytokine
expression and secretion, generation of enhanced oxidative stress, and increases in hepatocyte apoptosis. Furthermore,
liver-related death is a major cause of morbidity and mortality in HCV/HIV coinfected patients on antiretroviral therapy
therefore, anti-HCV treatment is advised to be considered for all HCV/HIV patients.
Unfortunately, treatment with pegylated interferon (PegIFN) plus ribavirin (RBV) has shown a low efficacy in these
patients, mainly among those coinfected with genotype 1. Triple therapy with PegIFN plus RBV and telaprevir or
boceprevir, the first approved direct-acting antiviral agents (DAAs) will improve the likelihood of cure for genotype 1
infected patients. Nevertheless, a significant number of coinfected patients are ineligible for IFN-containing regimens and
concerns remain in regard with drug-to-drug interactions and safety of triple therapy in cirrhotic patients.
Furthermore, therapeutic decisions today need take into account the promise of new DAAs, some combined in IFN-free
regimens, currently being investigated in multiple clinical trials to be in a near future, an easier, shorter and more effective
HCV treatment in HIV coinfected patients.
Keywords: Direct antiviral-acting agents, HCV/HIV coinfection, immunobiology, liver fibrosis, PegInterferon, treatment.
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