Hepatitis C and human immune deficiency coinfection at the era of highly active antiretroviral therapy.
Interactions between human immunodeficiency virus (HIV) and hepatitis C virus (HCV) have been widely studied before the introduction of highly active antiretroviral therapies (HAART). We reviewed the potential impact of HAART on hepatitis C as well as the interactions between HIV and HCV therapies. Physicians should be aware of the potential risk of: (i) symptomatic liver disease in HCV-HIV-coinfected patients at the era of triple antiretroviral therapy; (ii) potential liver deterioration paralleling immune restoration; (iii) lack of impact of triple antiretroviral therapy on HCV load; and (iv) potential drug-related hepatitis which may modify the natural history of HCV-related liver disease. Liver biopsies should be performed regularly in these patients in order to identify patients with severe liver disease who require early initiation of anti-HCV therapy under close monitoring of their immune status. Treatment is, to date, based on the combination of ribavirin and interferon with an expected sustained response rate around 25%. An important unresolved issue is to better delineate the temporal place of anti-HCV and anti-HIV antiviral therapies. At least in coinfected patients with significant liver disease, namely necro-inflammatory activity and/or fibrosis >or= 2, we believe that anti-HCV therapy is the priority since it lessens the risk of drug-induced hepatitis and of hepatitis due to immune restoration.
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Unité d'Hépatologie et INSERM U-370, Hôpital Necker, Paris, France. stanislas.pol@nck.ap-hop-paris.fr
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D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy* / Q000276:immunology / Q000401:mortality; D006801:Humans