Management and therapy of chronic hepatitis C in HIV.
OBJECTIVE
Chronic hepatitis C is currently one of the leading causes of hospitalization and death in HIV+ persons. Treatment is particularly challenging in coinfected patients due to lower efficacy and more side effects.


RESULTS
The combination of pegylated interferon plus ribavirin is the current treatment of choice. In the absence of contraindications, treatment should be provided with no restrictions up front (e.g., asking unnecessarily for a liver biopsy) and revisited at weeks 4 and 12. Treatment should only be continued in early virological responders. The use of standard ribavirin doses (1000-1200 mg/day) and for at least 12 months is crucial to maximize the effect of therapy. In patients with rapid virological response (undetectable viraemia at week 4), shorter periods of therapy (24 weeks) may be advisable for hepatitis C virus genotypes 2 and 3. Patients with low CD4 percentages should defer treatment and prioritize highly active antiretroviral therapy. Didanosine should never be co-administered with ribavirin due to potential life-threatening complications. When possible, zidovudine, stavudine and abacavir should be replaced by other agents having no deleterious interactions with ribavirin.


CONCLUSIONS
The treatment of chronic hepatitis C has become a priority in hepatitis C virus/HIV-coinfected patients, and the best results are obtained by tailoring therapy to the individual patient's characteristics.
aDepartment of Infectious Diseases, Spain bHepatology Unit, CIBEREHD, Hospital Carlos III, Madrid, Spain.
Vincent
V
Soriano
Eugenia
E
Vispo
Luz
L
Martin-Carbonero
Pablo
P
Labarga
Javier
J
Garcia-Samaniego
Pablo
P
Barreiro