HIV-infected patients are living longer since the introduction of
highly active antiretroviral therapy. However,
coinfection with the hepatitis C virus (HCV) leads to increased morbidity from
liver disease and higher overall mortality. The prevalence of
chronic hepatitis C among patients with HIV/
AIDS ranges from 7% (sexual transmission of HIV) to >90% (injection
drug use). Uncontrolled
HIV infection seems to accelerate the progression of HCV-induced
liver fibrosis. Forty-eight weeks of combination
therapy with pegylated
interferon alpha (2a or 2b) plus
ribavirin achieves a sustained viral response in coinfected individuals in up to 38% with HCV genotype 1 and up to 73% with genotypes 2 or 3. The safety profile of this treatment is similar to
therapy in HCV-monoinfected patients with
influenza-like symptoms,
cytopenia and neuropsychiatric symptoms dominating. However, HIV/HCV-coinfected patients who also take
zidovudine develop more profound anaemia than those on other HIV
nucleoside analogue
therapy.
Didanosine and
stavudine are associated with rare but serious mitochondrial toxicity, such as
pancreatitis or
lactic acidosis. It does not appear that the addition of
ribavirin increases that risk. There is currently no evidence that in HIV/HCV
coinfection one pegylated
interferon product is superior to the other. Contrary to common perception, it is also unproven that HIV/HCV-coinfected patients respond less well to
therapy with peginterferon alpha plus
ribavirin than HCV-monoinfected patients. Given the safety and efficacy of combination
therapy with peginterferon plus
ribavirin and the deleterious effects of
chronic hepatitis C, all HIV/HCV-coinfected patients should be evaluated for
therapy.