HCV treatment challenges in patients co-infected with HIV

Abstract

Infection with HCV is one of the most challenging co-morbidities emerging in HIV-infected patients in the post-antiretroviral therapy era. The co-infected population differs from the HCV mono-infected population in several aspects. HIV accelerates hepatic fibrosis progression, cirrhosis, end-stage liver disease, the development of hepatocellular carcinoma and death. Co-infected patients have a lower likelihood of achieving sustained virological response to treatment compared with mono-infected ones. A growing number of co-infected patients have a past history of nonresponse or relapse along with advanced liver disease. The simultaneous treatment of HCV and HIV may be associated with the occurrence of drug interactions, overlapping toxicities, and increased incidence and severity of side effects. This population is sorely in need of treatment. State-of-the-art management requires different strategies to achieve a cure with minimal adverse events. This review focuses on specific treatment challenges encountered in the current treatment of HCV in HIV-seropositive individuals.