HIV/HCV Co-infection: Pathogenesis, Clinical Complications, Treatment, and New Therapeutic Technologies

Abstract

World-wide, hepatitis C virus (HCV) accounts for approximately 130 million chronic infections, with an overall 3% prevalence. Four to 5 million persons are co-infected with HIV. It is well established that HIV has a negative impact on the natural history of HCV, including a higher rate of viral persistence, increased viral load, and more rapid progression to fibrosis, end-stage liver disease, and death. Whether HCV has a negative impact on HIV disease progression continues to be debated. However, following the introduction of effective combination antiretroviral therapy, the survival of coinfected individuals has significantly improved and HCV-associated diseases have emerged as the most important co-morbidities. In this review, we summarize the newest studies regarding the pathogenesis of HIV/HCV coinfection, including effects of coinfection on HIV disease progression, HCV-associated liver disease, the immune system, kidney and cardiovascular disease, and neurologic status; and effectiveness of current anti-HIV and HCV therapies and proposed new treatment strategies.

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

“…No anti‐HIV ART drugs are effective against HCV. In older children and adults, HCV coinfection is associated with more rapid HCV progression 142, 143 and may also have an adverse effect on HIV progression 142, and therefore early HIV treatment is recommended. Currently in children only combination treatment with pegylated interferon (PEG‐IFN) and ribavirin can be used to treat HCV infection.…”

HIV Co-Infection with Hepatotropic Viruses and Mycobacterial Tuberculosis

“…The mechanisms underlying accelerated liver disease in hepatotropic viruses/HIV co-infected individuals are poorly understood but may include the following: direct viral effects on hepatocytes and hepatic stellate cells, and immunologic alterations such as immune activation, apoptosis and diminished HCV specific Tcell reponses [60][61][62][63]. In addition, liver toxicity of antiretroviral drugs and the burden of metabolic disease may contribute to a faster progression of liver fibrosis in HIV/ HCV co-infection.…”

“…HIV immune activation induces cytokine changes (e.g. IL -4, IL -5, and IL -13, TGF -β) that increase liver inflammation and fibrosis [60,62,63]. Co-infection increases apoptosis of hepatocytes through a Fas/Fas L pathway that could account for accelerated liver disease [62,63].…”

“…Co-infection increases apoptosis of hepatocytes through a Fas/Fas L pathway that could account for accelerated liver disease [62,63]. Accumulation of cytotoxic CD8 T cells in the liver that increases inflammatory mediators in co-infected compared to HCV monoinfected patients may also lead to increased tissue damage in coinfected patients [60]. Recent evidence shows HIVspecific CD8 Tcells accumulate in the liver in co-infection and produce TNF -∞, which is associated with liver fibrosis [63,64].…”

A portable paper-based microfluidic platform for multiplexed electrochemical detection of human immunodeficiency virus and hepatitis C virus antibodies in serum

“…Due to their common routes of transmission, co-infection of HIV and HCV exists in an estimated one-third of HIV positive patients, [1][2][3][4] which is a severe health problem in the world, especially in developing countries. Infection with HIV, when present in either HCV transmitting or HCV exposed patients, can cause an increase on the risk of transmission of HCV; 5 apart from that, when exposed to HCV, HIV-infected patients are less likely to clear the acute infection.…”