HIV and hepatitis C virus coinfection: Approach to management

• Objective: To review screening, diagnosis, and treatment in patients with HIV and hepatitis C virus (HCV) coinfection. • Methods: Review of the literature in the context of a clinical case. • Results: All persons with HIV should be routinely screened for HCV infection, as chronic hepatitis C has become a major source of mortality among HIV-infected persons. The course of liver disease is more rapid in HIV/HCV coinfected persons, and the risk for cirrhosis is nearly twice that in persons with HCV monoinfection. Prior to therapy, it is important to assess for contraindications to treatment, such as uncontrolled depression or pregnancy, and to obtain HCV genotype and quantitative HCV RNA. The standard treatment regimen is pegylated interferon alfa with weight-based ribavirin. During treatment, regular monitoring for bone marrow suppression and depression from pegylated interferon and hemolytic anemia from ribavirin is necessary. Certain antiretrovirals, such as zidovudine and didanosine, should be avoided during treatment for HCV as they may worsen treatment-related side effects. Treatment options are limited in relapsers and nonresponders but may include retreatment or even consensus interferon; for decompensated liver disease, referral for liver transplantation should not be delayed. Specifically targeted anti-HCV agents are under investigation and appear promising in monoinfected persons. • Conclusion: Although much progress has been made in understanding HIV/HCV coinfection, an urgent need for further research remains.