Hepatitis C virus (HCV)
infection is a significant public health problem and one of the most important causes of chronic
liver disease worldwide.
Co-infection with HCV and HIV occurs frequently, mainly because both viruses share the same transmission routes. In recent years, the life expectancy of patients with HIV disease has been increased due to the introduction of
highly active antiretroviral therapy (
HAART). Furthermore, several studies have established that
HIV infection is associated with a major progression of the HCV-related
liver disease. Thus,
end-stage liver disease has become a leading cause of morbidity and mortality in this population, emphasising the importance of treatment of
chronic hepatitis C in HIV-infected persons. The
biological and histological benefit of
interferon-alpha (IFNalpha)
therapy in patients co-infected with HCV/HIV is not significantly different from that noted in similar patients without HIV when the
HIV infection is adequately controlled. However, patients with low CD4+ cell counts tend to respond poorly to anti-HCV
therapy.Given the relatively low sustained virological response rate to IFN alone, the use of IFNalpha monotherapy has been largely abandoned in favour of combination
therapy with
ribavirin. In the last 2 years, IFN plus
ribavirin combination
therapy has been the standard care for the treatment of
chronic hepatitis C. Although information on the safety and efficacy of this dual
therapy in HCV/HIV co-infected patients is scarce, recent trials have reported that the combination of IFN plus
ribavirin is well tolerated and feasible in patients co-infected with HCV/HIV. However, the rates of sustained virological response seem to be worse than those observed in patients without
HIV infection. New IFN formulations (e.g. pegylated
interferon) plus
ribavirin appear to be way of the future for the treatment of
chronic hepatitis C in patients both with and without HIV
co-infection.