Natural history of HIV and HCV coinfection.

The natural history of hepatitis C virus (HCV) infection is altered by human immunodeficiency virus (HIV) coinfection. Plasma HCV RNA is higher in HIV-infected patients and may further increase as HIV immune deficiency progresses. Hepatic fibrosis and clinical features of hepatic dysfunction develop more rapidly in HIV/HCV coinfection than in HCV alone. Although HIV/HCV-coinfected patients may progress more rapidly to AIDS, other confounding variables include comorbidities, substance abuse, and social issues. Alcohol consumption accelerates both HCV and HIV disease. Given these interactions and the high prevalence of HIV/HCV coinfection, chronic HCV infection will greatly affect the morbidity, mortality, and medical management of HIV patients, and HIV will also affect the care of patients with HCV.