[Treatment of chronic hepatitis C in patients with HIV infection]

Treatment of chronic hepatitis C in patients infected with the human immunodeficiency virus (HIV) is recommended when: 1) aminotransferase levels are repeatedly elevated; 2) CD4+ blood cell counts are above 350 per microl; and 3) HIV RNA plasma levels are less than 50 000 copies per milliliter. Treatment is not recommended for patients who inject illegal drugs, consume large amount of alcohol, or have a severe psychiatric disorder. Treatment of patients with normal aminotransferase levels can be considered in the context of a clinical trial or if stage F2 or worse has been histologically confirmed on a liver biopsy specimen. Liver biopsy is generally recommended prior to treatment. However, because of faster progression to fibrosis in HIV and hepatitis C virus (HCV) coinfected patients, if the patient declines liver biopsy it should not exclude him from treatment. Treatment with interferon and ribavirin (800 mg/day orally) is recommended. Pegylated interferon is preferred (180 microg of alfa-2a form and 1.5 mg/kg of alfa-2b form once weekly subcutaneously) because of poor results with the conventional form of interferon, however, treatment with conventional interferon (3 times weekly 3 million units subcutaneously) can be considered in HCV genotype 2 or 3 infection. All genotypes should be treated for 48 weeks. Since only patients who have a decline of HCV viremia of at least 2 logarithms after 12 weeks of treatment have a chance of cure, treatment should be discontinued in patients who do not achieve this target. Concurrent treatment with zidovudine and didanosine should be avoided because of additive toxicity. One should also be cautious when antiretroviral drugs with a greater potential for hepatotoxicity (nevirapine, ritonavir) are concurrently administered.