Treating hepatitis C in HIV-HCV coinfected patients

As the natural history of HIV infection has changed following the introduction of highly active antiretroviral therapy (HAART), morbidity and mortality in the afflicted patients could be significantly reduced. The decreasing risk of suffering from opportunistic infections and tumors, however, is at the cost of antiretroviral drug-related toxicities. Today, mortality by liver disease is the major cause of death in HIV-infected patients from industrial countries. In the US and Europe about 30% of HIV-positive individuals are also infected with hepatitis C virus (HCV), and approximately 50-90% of persons who acquired HIV from injecting drugs are coinfected with HCV. In these dually infected individuals the presence of each viral infection impacts the natural history of the other one, and worsening of associated liver disease and complications within this population are increasing. The management of chronic hepatitis C (cHC) in HCV-HIV coinfection has become a major challenge, since possible interactions with antiretroviral therapies, increased risk of special side effects and compromises in adherence in patients already taking several drugs have to be taken into account. On the other hand, treatment strategies to fight HCV have been essentially ameliorated during the past 2 years by using pegylated interferon-alpha2b (Peg-IFN-alpha2b) combined with ribavirin, and there is hope that the successful therapeutic outcome in HCV-monoinfected individuals may beat least partly translated into benefits for the difficult-to-treat population of HCV-HIV dually infected persons. During the 15th International AIDS Conference in July 2002 in Barcelona, a satellite symposium, as well as a session in the main program and a number of poster presentations focussed on HCV-HIV coinfection and addressed the urgent problems and therapeutic challenges in managing cHC in the situation of underlying HIV disease.