Challenges in the management of HIV and hepatitis C virus co-infection.

Hepatitis C virus (HCV) has become a significant contributor to morbidity and mortality to those infected with HIV since the introduction of highly active antiretroviral therapy (HAART). The presence of HIV clearly has a negative effect on the natural history of HCV, although there is some debate over whether HCV influences the natural history of HIV. Given the prevalence of co-infection and the accelerated liver damage from HCV, treatment of chronic HCV infection is an important consideration in patients co-infected with HIV. There are few studies of pegylated interferon and ribavirin in co-infected populations, but it seems that the treatment is well tolerated, although it is possibly less effective in this group. HAART in the setting of HCV infection also requires some special consideration, namely an increased incidence of hepatotoxicity. Treatment of co-infected patients requires close monitoring as current therapies are not ideal in terms of effectiveness, and toxicity may be severe.