title: HCV and HIV co-infection: mechanisms and management.
abstract: HCV and HIV co-infection is associated with accelerated hepatic fibrosis progression and higher rates of liver decompensation and death compared to HCV monoinfection, and liver disease is a leading cause of non-AIDS-related mortality among HIV-infected patients. New insights have revealed multiple mechanisms by which HCV and HIV lead to accelerated disease progression, specifically that HIV infection increases HCV replication, augments HCV-induced hepatic inflammation, increases hepatocyte apoptosis, increases microbial translocation from the gut and leads to an impairment of HCV-specific immune responses. Treatment of HIV with antiretroviral therapy and treatment of HCV have independently been shown to delay the progression of fibrosis and reduce complications from end-stage liver disease among co-infected patients. However, rates of sustained virologic response with PEG-IFN and ribavirin have been significantly inferior among co-infected patients compared with HCV-monoinfected patients, and treatment uptake has remained low given the limited efficacy and tolerability of current HCV regimens. With multiple direct-acting antiviral agents in development to treat HCV, a unique opportunity exists to redefine the treatment paradigm for co-infected patients, which incorporates data on fibrosis stage as well as potential drug interactions with antiretroviral therapy.
authors.affiliation: Liver Center and Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Chen
authors.affiliation: Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Eoin R
authors.initials: ER
authors.lastname: Feeney
authors.affiliation: Liver Center and Division of Gastroenterology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Chung
mesh_terms: D000465:Algorithms; D060085:Coinfection / Q000188:drug therapy; D018450:Disease Progression; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D006526:Hepatitis C / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans