Hepatitis C virus in human immunodeficiency virus-infected individuals: an emerging comorbidity with significant implications.

As antiretroviral (ARV) therapy has become more effective, hepatitis C virus (HCV) infection has emerged as an important cause of morbidity and mortality in human immunodeficiency virus (HIV)-infected individuals. HIV alters HCV clinical presentation, epidemiology, virology, and pathogenesis compared with HCV monoinfected individuals. The incidence of chronic and vertical HCV infection is increased, the rate of hepatic fibrosis progression is accelerated, peripheral and intrahepatic HCV RNA levels are increased, and end-stage liver disease (ESLD) and cirrhosis develop more rapidly in coinfected individuals. Based on these observations, combined with the increased efficacy of ARV therapy, several societies have recommended the diagnosis and treatment of HCV in coinfected individuals. HCV treatment with nonspecific antivirals, pegylated interferon alpha (PEG-IFN) and ribavirin (RBV), is more complex in coinfected individuals compared with monoinfected individuals because these regimens appear to have decreased efficacy and the incidence of complications is increased. Although new HCV-specific regimens show early promise in HCV monoinfected individuals, it is likely that these agents will be used in combination with nonspecific therapies and additional studies will be required to evaluate their efficacy in coinfected individuals.