Hepatic complications currently represent one of the leading reasons for medical consultations, hospitalisation, and death in the HIV-infected population. This is due to a large extent to viral
hepatitis, given its disproportionate frequency in this population.
Chronic hepatitis B affects 5-10% of the HIV-infected population. Vaccination has reduced the incidence of
liver disease related to hepatitis-B virus (HBV), and the availability of
tenofovir has dramatically improved the prognosis of HIV/HBV carriers.
Delta hepatitis affects around 15% of HIV-infected individuals in Europe harbouring positive
HBsAg. It has the worst prognosis, given its accelerated course to
cirrhosis and the absence of successful therapy. Lastly,
chronic hepatitis C is the major cause of
liver disease in the HIV population. Although classically linked to persons infected parenterally (i.e., intravenous drug users), outbreaks of acute
hepatitis C among homosexual men have been reported over the last decade. Treatment with pegylated
interferon plus
ribavirin provides a cure in less than 40% of patients. However, the introduction of new direct acting
antivirals against hepatitis- C virus (HCV) (
telaprevir,
boceprevir) has revolutionised the field, as
HAART did in 1996 in the HIV field, improving the prognosis of co-infected patients. However, interactions between these drugs and
antiretroviral agents and the risk of selective resistance pose huge threats in this population.