Hepatitis C and human immunodeficiency virus infection

Abstract

In the United States, an estimated 200,000 persons are infected with both hepatitis C virus (HCV) and human immunodeficiency virus (HIV). As the lives of HIV-infected persons have been prolonged by use of highly active antiretroviral therapy, liver disease has emerged as an important, and in some settings, the leading cause of morbidity and mortality. Human immunodeficiency virus infection appears to adversely affect all stages of hepatitis C infection, leading to increased viral persistence and accelerated progression of HCV-related liver disease. In turn, hepatitis C may affect the management of HIV infection, increasing the incidence of liver toxicity caused by antiretroviral medications. The medical management of hepatitis C in HIV-infected persons remains controversial, in part because of the complexity of both infections and potential drug interactions, but chiefly because there is so little published information. Nonetheless, the burden of liver disease is too high to delay management of HIV/HCV-coinfected persons while awaiting better data. Instead, the management of hepatitis C today must be based on data generated on persons without HIV and an understanding of both infections. Properly designed studies of therapy in HIV/HCV-coinfected persons are needed to help guide management of these patients in the future. (Table 1). In this review, the epidemiology, natural history, and management of hepatitis C are considered in the HIV-infected person using the available Iiterature to provide recommendations and, when necessary, highlight areas of controversy. Abbreviations: HCK hepatitis C virus; HIK human immunodejciency virus;HAART, high4 active antiretroviral medication; anti-HBc, antibody to hepatitis B core antigen.

HIV coinfection shortens the survival of patients with hepatitis C virus-related decompensated cirrhosis

“…20 In this sense, the effects of HIV infection on the immune response to HCV may play a pivotal role. 21 Moreover, HIV coinfection may lead to increased hepatocyte apoptosis, 22 which could worsen liver fibrosis. 23 Finally, some hepatotoxic antiretroviral drugs commonly used in HCV/HIV-coinfected patients, such as nevirapine, may enhance the progression of liver fibrosis.…”

Review article: chronic hepatitis C – natural history and cofactors

“…28 Approximately 25% of subjects infected with HIV are also infected with HCV. After the introduction of highly active anti-retroviral therapies (HAART) the overall mortality for AIDS and related opportunistic coinfection has declined sharply and liver disease due to HCV has emerged as an important cause of death in HCV/HIVcoinfected patients.…”

Injection Drug Use and the Hepatitis C Virus: Considerations for a Targeted Treatment Approach--The Case Study of Canada

“…55 Interactions with HIV have been shown to occur on the immunological level, with HIV-infected individuals exhibiting accelerated adverse outcomes and the possibility of increased risk of HCV infection in the presence of HIV. 43,56,57 Also, HCV infection is more prevalent in alcoholics, 58,59 and alcohol dependence is common in illicit drug users 60 ; thus, IDUs consuming alcohol are at increased risk. There are thus a number of biological factors, most relating to immunosuppression, that may lead to enhanced HCV infectivity in IDUs.…”