16 Hepatitis C virus and human immunodeficiency virus coinfection

Publisher Summary This chapter focuses on the interaction between hepatitis C virus (HCV) and HIV, defining the prevalence of the problem, the role of HIV infection in the natural course of HCV infection, and current treatment options available for coinfected individuals. HCV and HIV share similar modes of transmission and it is not surprising that certain groups have a high rate of HIV-HCV co-infection. These groups are injection drug users and recipients of blood or blood products made before the introduction of routine screening for HCV and HIV and the use of viralinactivation procedures. Hepatitis C appears to be somewhat more severe among HIV co-infected persons than in persons with hepatitis C alone and progression of disease to cirrhosis can occur more rapidly. Therapy of hepatitis C in HIV infected patients is difficult, because these patients frequently have other major medical problems and are taking other medications that make combination treatment of interferon-a and ribavirin difficult. Nevertheless, several small studies have suggested that patients with HIV infection and adequate CD4 counts respond to therapy of hepatitis C at a rate that is similar to that among patients without HIV infection. Studies of the combination of interferon-α and ribavirin in HIV infected patients are needed particularly focused upon management of the multiple antiviral agents during the period of therapy.