Pathogenesis of Liver Damage in HCV-HIV Patients

The coinfection of HIV and HCV has become a pathology with several distinctive characteristics. Pathogenesisof liver damage in patients with HIV and HCV coinfection is complex and multifactorial. It derives froma balance of factors which interact among themselves in a dynamic way. The reasons for the acceleratedcourse of HIV/HCV coinfection are mainly related to two principal causes: the persistence of HCV, whichdepends upon alterations of cell-mediated immunity, and the activation of the immune system towardssecretion of proinflammatory and profibrotic cytokines. This review will first focus on the characteristics ofboth these immune-mediated mechanisms, and then their implication on fibrogenesis as well as on otherpathogenetic mechanisms, such as interactions between viruses and the deficit of protective mechanisms.A better knowledge of adaptive immune mechanisms, cytokine alteration, interference withhost defense mechanisms, and the “cross-talkâ€? among the viruses will improve the understanding ofthe pathogenetic mechanism and provide the opportunity to cure this disease.