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JAC Advance Access originally published online on November 24, 2005
Journal of Antimicrobial Chemotherapy 2005 56(6):991-995; doi:10.1093/jac/dki392
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Published by Oxford University Press 2005

Leading article

Chronic hepatitis C in patients with HIV/AIDS: a new challenge in antiviral therapy

Norbert Bräu*

Department of Medicine, Divisions of Infectious Diseases and Liver Diseases, Mount Sinai School of Medicine, New York, NY, USA and the Veterans Affairs Medical Center, Bronx, NY, USA

* Mount Sinai School of Medicine, Bronx Veterans Affairs Medical Center, Infectious Disease Section (111F), 130 West Kingsbridge Road, Bronx, NY 10468, USA. Tel: +1 718 584 9000; Fax: +1 718 367 4850; E-mail: norbert.brau{at}med.va.gov

HIV-infected patients are living longer since the introduction of highly active antiretroviral therapy. However, coinfection with the hepatitis C virus (HCV) leads to increased morbidity from liver disease and higher overall mortality. The prevalence of chronic hepatitis C among patients with HIV/AIDS ranges from 7% (sexual transmission of HIV) to >90% (injection drug use). Uncontrolled HIV infection seems to accelerate the progression of HCV-induced liver fibrosis. Forty-eight weeks of combination therapy with pegylated interferon alpha (2a or 2b) plus ribavirin achieves a sustained viral response in coinfected individuals in up to 38% with HCV genotype 1 and up to 73% with genotypes 2 or 3. The safety profile of this treatment is similar to therapy in HCV-monoinfected patients with influenza-like symptoms, cytopenia and neuropsychiatric symptoms dominating. However, HIV/HCV-coinfected patients who also take zidovudine develop more profound anaemia than those on other HIV nucleoside analogue therapy. Didanosine and stavudine are associated with rare but serious mitochondrial toxicity, such as pancreatitis or lactic acidosis. It does not appear that the addition of ribavirin increases that risk. There is currently no evidence that in HIV/HCV coinfection one pegylated interferon product is superior to the other. Contrary to common perception, it is also unproven that HIV/HCV-coinfected patients respond less well to therapy with peginterferon alpha plus ribavirin than HCV-monoinfected patients. Given the safety and efficacy of combination therapy with peginterferon plus ribavirin and the deleterious effects of chronic hepatitis C, all HIV/HCV-coinfected patients should be evaluated for therapy.

Keywords: pegylated interferon , ribavirin , highly active antiretroviral therapy , drug interactions


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