[Coinfection with hepatitis C virus and HIV]

The life expectancy of patients with an HIV infection has improved dramatically since the introduction of highly active anti-retroviral therapy (HAART). Retrospective studies have shown that since then, hospital admissions and mortality caused by a co-infection with hepatitis C virus (HCV) have increased. Patients with an HIV-HCV co-infection exhibit on average a more rapid progression to liver cirrhosis and liver failure than patients with an HCV monoinfection. It is expected that a co-infection with HCV will lead to serious complications among some of the HIV-infected population. It is therefore recommended that all HIV-infected patients be screened for a co-infection with HCV. The treatment of an HCV co-infection needs to be considered. The first choice therapy will probably be a combination of peginterferon and ribavirin, although final conclusions about the safety and efficacy are still awaited. A combination of ribavirin with zidovudine or didanosine is best avoided. Developments being made with new classes of drugs, such as HCV-specific protease inhibitors and polymerase inhibitors, seem promising.