HIV coinfection with hepatitis c

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]

Overview

In HIV–HCV co-infected patients, the Hepatitis C (HCV) viral load is higher than in HCV-mono-infected patients in both the plasma and liver tissue.

Cause of Co-infection

Patients who are HIV-positive are commonly co-infected with HCV due to the following:

• shared routes of transmission
• percutaneous exposure to blood
• sexual intercourse
• from a mother to her infant.

Recommendations for Diagnosis and Treatment of Persons with HIV Coinfection: AASLD Practice Guidelines 2009

“

1. Anti-HCV testing should be performed in all HIV-infected persons (Class I, Level B). 2. HCV RNA testing should be performed to confirm HCV infection in HIV-infected persons who are positive for anti-HCV, as well as in those who are negative and have evidence of unexplained liver disease (Class I, Level B). 3. Hepatitis C should be treated in the HIV/HCV co-infected patient in whom the likelihood of serious liver disease and a treatment response are judged to outweigh the risk of morbidity from the adverse effects of therapy (Class I, Level A). 4. Initial treatment of hepatitis C in most HIV infected patients should be peginterferon alfa plus ribavirin for 48 weeks at doses recommended for HCV mono-infected patients (Class I, Level A). 5. When possible, patients receiving zidovudine (AZT) and especially didanosine (ddI) should be switched to an equivalent antiretroviral agent before beginning therapy with ribavirin (Class I, Level C). 6. HIV-infected patients with decompensated liver disease (CTP Class B or C) should not be treated with peginterferon alfa and ribavirin and may be candidates for liver transplantation (Class IIa, Level C).

”