Update on the Treatment of Chronic Hepatitis C in HIV-infected Patients
Vicente Soriano 1, Pablo Barreiro 2, Luz Martín-Carbonero 3, Eugenia Vispo 3, Javier García-Samaniego 3, Pablo Labarga 3
1 UNIR Health Sciences School and Medical Center, Universidad Internacional de La Rioja, Madrid, Spain; 2 Department of Infectious Diseases, Hospital Carlos III-La Paz University Hospital. Madrid, Spain; 3 NULL
*Correspondence: Eugenia Vispo, Email not available
Abstract
Liver disease is currently the second leading cause of death in HIV-infected persons in Western countries.Hepatitis C virus infection accounts for the majority of cases of hepatic illness in this population. Althoughgreat progress has been made in the treatment of chronic hepatitis C in HIV-positive patients, many challengesstill remain unsolved. The combination of pegylated interferon plus ribavirin is the current treatmentof choice in hepatitis C virus/HIV-coinfected patients, regardless of hepatitis C virus genotype. However, thelimited efficacy of this therapy in the HIV setting makes necessary the development of new strategies and/ordrugs for the treatment of hepatitis C infection. Several anti-hepatitis C virus compounds are currently underinvestigation, although most are still in the early stages of clinical development. There is a relatively largegroup of patients who will be unable to be treated with the current hepatitis C virus medication based oninterferon, mainly due to contraindications such as serious neuropsychiatric or cardiovascular history. However,for those without contraindications, treatment should be provided with no restrictions at the start (e.g.asking unnecessarily for a liver biopsy), and reassessed at weeks 4 and 12, considering virologic responses.Treatment should only be continued in early virologic responders. The use of standard doses of ribavirin(1000-1200 mg/day) and for at least 12 months seems crucial to maximize the effect of current hepatitis Ctreatment in the HIV setting, while no further benefit seems to derive from using higher than recommendedpegylated interferon dosages. In patients with rapid virologic response (undetectable viremia at week 4) toanti-hepatitis C therapy, shorter periods of therapy (24 weeks) may be advisable in hepatitis C genotypes 2and 3. Finally, adequate selection of candidates and careful selection of concomitant antiretroviral medicationsmust be encouraged. Patients with low CD4 percentages (<15%) should be deferred for treatment andHAART prioritized in order to improve CD4 counts. When possible, nucleoside analogs such as zidovudine,stavudine, and abacavir should be replaced by others having no deleterious interactions with ribavirin (e.g.tenofovir, lamivudine, or emtricitabine). Didanosine should never be coadministered with ribavirin due topotential life-threatening complications.
