Human Immunodeficiency Virus and Hepatitis C Virus Coinfection: Epidemiology, Natural History, Therapeutic Options and Clinical Management

Abstract

Due to shared risk factors for transmission, coinfection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is a very common event. The prevalence of HCV infection among HIV-positive patients averages about 35% in the United States and Europe, but in clinical populations where there is a great prevalence of intravenous drug use as a risk factor for acquiring HIV, this value may be as high as 80-90%. Several studies have confirmed that HIV coinfection accelerates the natural course of chronic hepatitis C and an increased risk of liver cirrhosis, hepatocellular carcinoma, and decompensated liver disease has been found in coinfected subjects. Other studies have shown an increased risk of progression to acquired immunodeficiency syndrome (AIDS) and AIDS-related death among HIV-HCV-positive persons, suggesting that HCV coinfection may accelerate the course of HIV disease. In addition, hepatitis C may affect the management of HIV infection, increasing the incidence of liver toxicity associated with the antiretroviral regimens. The optimal therapeutic approach to HCV infection in HIV coinfected patients is still uncertain, because of the complex pathogenesis of both infections, potential drugdrug interactions, and the poor literature and information available about safety and efficacy of an interferon (IFN) and ribavirin combination in this clinical population. Available data show that the sustained virological response rates in coinfected persons treated with standard IFN plus ribavirin range from 18-40%, and several studies with pegylated IFN plus ribavirin are ongoing.

Assessment of hepatitis B virus and hepatitis C virus infections and associated risk factors in HIV infected patients at Debretabor hospital, South Gondar, Northwest Ethiopia

“…Newly HIV infected patients who received their HIV status after the data collection started and HIV patients less than 18 years old were excluded due to difficulty of obtaining consent.…”

“…Approximately four to five million HIV patients are coinfected with HCV globally [3] . In these patients, HIV virus weakens the immune response to HCV resulting in a lower probability of spontaneous viral clearance of HCV infection, higher levels of HCV RNA in the blood, more rapid progression to HCV-related end stage liver disease and increased risk of antiretroviral associated liver toxicity [16][17][18] . The problems listed above highlight the importance of preventing further spread of HBV and HCV infections in HIV-infected patients as well as diagnosing existing infections.…”

HIV Co-Infection with Hepatotropic Viruses and Mycobacterial Tuberculosis

“…Co-infection with HIV and hepatotropic viruses is a common growing public health problem [78]. Co-infection alters the natural history of each of these viruses in a peculiar way.…”

“…There is controversy in this management up till date, because of the complex pathogenesis of these infections, potential drug interactions, the poor literature and information available about safety and efficacy of an interferon and ribavirin combination in this group of patients [78]. Studies have shown that virological response rates in co-infected persons treated with standard interferon plus ribavirin range from 18-40% and several studies with pegylated interferon plus ribavirin are inconclusive and its outcome poorly understood [76].…”

Dilemma of concepts and strategies for the prevention of spread of HIV in relation to human behavior, law and human rights

“…These statements (see Paragraph 2 in Scetion 6) neglect that "victims" of HIV infection covered by the "… respect HR" principle, in turn become offenders when they themselves transmit HIV to a partner(s), thereby violating HR whether aware or unaware of their HIV status. This is further reflected, for example, in high risk behavior resulting in the spread of not only HIV but HBV, HCV, and other STIs or combinations thereof (Verucchi et al, 2004;Serpaggi et al, 2006;Urbanus et al, 2009). HCV has gained access to communities in Europe via social networks (Vachta et al, 2009).…”