Hepatic histology of patients with HIV infection and chronic hepatitis C treated with interferon

Clinical trials of treatment for hepatitis C virus infection in HIV-infected patients: past, present, and future

Coinfection with hepatitis C virus (HCV) and human immunodeficiency virus (HIV) type 1 is common. Rates of liver-related morbidity and mortality have been increasing in the coinfected population, and treatment for HCV infection in this group remains a challenge. The HCV-monoinfected population, especially patients infected with HCV genotype 2 or 3, has benefited dramatically from the advent of treatment with pegylated interferon plus ribavirin; rates of sustained virological response approach 55%. Coinfected patients lag behind, with rates of sustained virological response ranging between 26% and 40%; rates of sustained virological response are even lower among patients infected with HCV genotype 1. It is encouraging, however, that therapies known to be safe for treating monoinfected patients have been proven to be generally safe and well tolerated in patients coinfected with HIV and HCV, as well. Future therapies, some of which are currently in development, will likely include new targets, such as helicase and polymerase. It is hoped that, as more-effective agents are discovered, the disparity in treatment response will diminish.

HIV-HCV Coinfection

Human immunodeficiency virus and hepatitis C virus are global health concerns. Due to shared routes of transmission, coinfection is common. Since the introduction of highly active antiretroviral therapy in the mid-1990s and the associated marked reduction in HIV-related mortality, the incidence of liver-related mortality in coinfected patients has risen significantly. This rise has led to increased research into the evaluation and management of the coinfected patient. This article reviews the epidemiology and evaluation of the coinfected patient and outlines the principles necessary for successful management of this challenging patient population.

Role of Liver Biopsy in the Evaluation of Hepatitis C Virus Infection in HIV Coinfection

Hepatitis C virus (HCV) coinfection is common in patients infected with human immunodeficiency virus (HIV), because the viruses share common routes of transmission. With the marked increase in life expectancy of HIV-infected patients associated with the use of highly active antiretroviral therapy, HCV infection has become a significant cause of morbidity and mortality in coinfected patients. As a result, there has been increasing attention to adequate assessment of HCV infection during the last several years. Unlike liver enzymes and HCV RNA levels, which can fluctuate widely and do not correlate with the severity of disease, liver biopsy has become the cornerstone in the evaluation of chronic HCV infection. However, there remain important questions and controversies related to adequately determining the histological severity of liver disease and the role of liver biopsy in HIV-HCV-coinfected patients.

The clinical spectrum of hepatitis C virus in HIV coinfection

The biochemical, virologic, and histologic spectrum of hepatitis C virus (HCV) in 66 consecutive patients with HIV-HCV coinfection and 119 HCV controls was compared: 86% of coinfected patients had CD4 counts >200 cells/mm3, 51% had a normal alanine aminotransferase (ALT) value, the mean HCV RNA titer was 5.7 log IU/mL, 92% of coinfected patients were of genotype 1, and the mean histologic activity index was 6.86 with advanced fibrosis in 32% of patients. The biochemical, virologic, and histologic findings of HCV in coinfected patients were similar to those observed in HCV controls. For both groups of patients, no clinical, biochemical, or virologic factors could reliably identify patients with advanced fibrosis or cirrhosis, underscoring the importance of liver biopsy in the evaluation of these patients. The spectrum of liver disease in coinfection includes a significant proportion of patients with normal ALT values, and excluding these patients from previous studies has led to an overestimation of HCV disease severity.