Management of HCV-Related End-Stage Liver Disease in HIV-Coinfected Patients

End-stage liver disease due to hepatitis C virus has become a major challenge in the managementof HIV/HCV-coinfected patients. The diagnosis and management of cirrhosis and its complications inthe scenario of HIV/HCV-coinfection are reviewed. Noninvasive approaches to the diagnosis of cirrhosis,such as biomarkers or transient hepatic elastography, may be considered. The clinical profileof cirrhosis decompensation in the coinfected population is different from that found in HCV-monoinfectedindividuals. Ascites and hepatic encephalopathy are much more frequent, whereas hepatocellularcarcinoma is still uncommon, when simultaneous hepatitis B virus infection is absent. Thenewest and more conflicting topics on the management of these complications are also discussed.Liver transplantation seems to be a proper option of treatment in HIV/HCV-coinfected patients andshould be considered early in their management, since mortality after the first hepatic decompensationis high.