Current concepts in the management and treatment of hepatitis C in HIV-infected patients.

Chronic hepatitis C virus (HCV) infection is very common among HIV-positive patients who were infected through intravenous drugs use or contaminated blood products (e.g., hemophiliacs). An increase in liver-related deaths among HIV-positive subjects co-infected with HCV has been acknowledged over the last years. HIV infection has a negative impact on the natural history of chronic hepatitis C, accelerating the progression of liver fibrosis. Moreover, interactions between anti-HIV and anti-HCV drugs are of concern, and a lower response to anti-HCV therapy limits its benefit in the HIV/HCV-coinfected population. Regarding treatment monitoring, the stopping rule at week 12 recommended for HCV-monoinfected individuals, seems to be equally valid in HIV-infected patients. This finding is of great value, since it allows to offer treatment in the absence of contraindication (e.g., low CD4 counts, alcohol abuse, etc), discontinuing it as soon as at 12 weeks after initiation when no chances of cure are anticipated, saving costs and deleterious side effects. There are important barriers to HCV treatment in HIV/HCV-coinfected patients, which are necessary to be addressed in order to increase the eligibility and applicability of HCV therapy in this population. In addition, strategies aimed to improve tolerance of the HCV medication with adequate support as well as to enhance the response to current available therapies, including individualized tailoring of drug dosages and length of treatment, should be pursuit to enhance the rate of treatment success. Finally, new anti-HCV drugs currently under development are eagerly awaited for the growing number of HCV/HIV-coinfected patients non-responders or relapsers to the current therapy.