title: Current management of hepatitis C virus infection in patients with HIV co-infection.
abstract: As a result of shared routes of transmission, coinfection with hepatitis C virus (HCV) is common in human immunodeficiency virus (HIV)-infected patients. The prevalence of HIV/HCV coinfection is particularly high among persons who have used injection drugs; however, more recently, sexual transmission of HCV has been recognized among HIV-infected men who have sex with men (MSM). Over the past decade, the effectiveness of HIV treatment improved substantially, leading to a substantial reduction in HIV/AIDS-related deaths; in this context, liver disease due to HCV infection has emerged as major concern for co-infected patients. Over the same period, treatment of HCV remained stagnant, with pegylated interferon alfa (PegIFN) plus ribavirin (RBV; PegIFN/RBV) entrenched as the standard treatment for HCV infection for co-infected patients, who have the greatest risk for liver disease. However, the effectiveness of HCV treatment in this population has been disappointing because of low rates of treatment initiation and success. In 2011, novel HCV NS3/4A PIs (PIs), telaprevir and boceprevir, were approved for use in combination with PegIFN/RBV for the treatment of HCV genotype 1 infection; at the time of approval, important questions regarding the efficacy, safety, and potential for drug interactions with telaprevir and boceprevir had not been answered. More recently, data from drug-interaction studies and 2 small, phase II clinical trials indicate that these HCV treatment regimens may lead to higher rates of HCV eradication in HIV/HCV-coinfected patients, with manageable toxicity and pharmacologic interactions with antiretroviral drugs. As such, these HCV PI-based regimens have emerged as the standard for the treatment of HCV genotype 1 infection in carefully selected HIV-infected patients.
authors: Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD 21287, USA. msulkowski@jhmi.edu
authors: Mark S
authors: MS
authors: Sulkowski
mesh_terms: D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002986:Clinical Trials as Topic; D060085:Coinfection / Q000628:therapy*; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods; D015658:HIV Infections / Q000150:complications* / Q000628:therapy*; D006526:Hepatitis C / Q000150:complications* / Q000628:therapy*; D006801:Humans; D008297:Male; D009842:Oligopeptides / Q000008:administration & dosage / Q000009:adverse effects; D011392:Proline / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D009842:Oligopeptides; C486464:telaprevir; C512204:N-(3-amino-1-(cyclobutylmethyl)-2,3-dioxopropyl)-3-(2-((((1,1-dimethylethyl)amino)carbonyl)amino)-3,3-dimethyl-1-oxobutyl)-6,6-dimethyl-3-azabicyclo(3.1.0)hexan-2-carboxamide; D011392:Proline
references: N Engl J Med. 2009 Apr 30;360(18):1815-26
references: 19339714
references: AIDS. 2008 Oct 1;22(15):1979-91
references: 18784461
references: AIDS. 2010 Jun 19;24(10):1537-48
references: 20453631
references: JAMA. 2012 Jul 25;308(4):370-8
references: 22820790
references: Drug Alcohol Depend. 2006 Feb 28;81(3):259-65
references: 16129567
references: N Engl J Med. 2011 Jun 23;364(25):2417-28
references: 21696308
references: Annu Rev Med. 2008;59:473-85
references: 18186707
references: Br J Clin Pharmacol. 2013 Feb;75(2):431-9
references: 22642697
references: J Viral Hepat. 2010 Oct;17(10):714-9
references: 20002560
references: Ann Intern Med. 2012 Dec 4;157(11):817-22
references: 22910836
references: HIV Clin Trials. 2012 May-Jun;13(3):142-52
references: 22592094
references: J Community Health. 2008 Jun;33(3):126-33
references: 18165889
references: Gastroenterology. 2012 May;142(6):1324-1334.e3
references: 22537439
references: AIDS. 2009 Jul 31;23(12):F1-7
references: 19542864
references: Clin Gastroenterol Hepatol. 2011 Jun;9(6):509-516.e1
references: 21397729
references: J Antimicrob Chemother. 2010 Jun;65(6):1079-85
references: 20335191
references: Ann Hepatol. 2012 Mar-Apr;11(2):179-85
references: 22345334
references: Clin Infect Dis. 2002 Mar 15;34(6):831-7
references: 11833007
references: N Engl J Med. 2011 Jun 23;364(25):2405-16
references: 21696307
references: Clin Infect Dis. 2012 Nov 15;55(10):1408-16
references: 22893583
references: JAMA. 2002 Jul 10;288(2):199-206
references: 12095384
references: Ann Intern Med. 2012 Feb 21;156(4):271-8
references: 22351712
references: J Hepatol. 2012 Feb;56(2):320-5
references: 21756855
references: Am J Gastroenterol. 2010 May;105(5):989-1004; quiz 988, 1005
references: 20087331
references: Hepatology. 2011 Oct;54(4):1433-44
references: 21898493
references: J Gen Intern Med. 2007 Jun;22(6):822-5
references: 17503108
references: Clin Infect Dis. 2012 Apr;54(7):979-83
references: 22173234
references: Hepatology. 2009 Apr;49(4):1335-74
references: 19330875
references: N Engl J Med. 2004 Jul 29;351(5):438-50
references: 15282351
references: N Engl J Med. 2011 Mar 31;364(13):1195-206
references: 21449783
references: AIDS. 2007 May 11;21(8):983-91
references: 17457092
references: JAMA. 2012 Jul 25;308(4):387-402
references: 22820792
references: AIDS. 2006 Nov 28;20(18):2361-9
references: 17117023
references: Clin Infect Dis. 1999 Jul;29(1):150-4
references: 10433578
references: N Engl J Med. 2011 Mar 31;364(13):1207-17
references: 21449784
references: Gastroenterology. 2009 May;136(5):1609-17
references: 19422083