New paradigms in the management of hepatitis C virus co-infections

Liver disease has emerged as a major contributor to morbidity and mortality in patients with HIV infection. Hepatitis C virus (HCV) infection is a key element in the etiology of liver-associated injury in this population. Increased rates of fibrotic progression have been described and are mediated by alcohol use, the severity of immunosuppression, the use of antiretroviral therapy, and other factors. Large clinical trials have demonstrated the efficacy of treatment with pegylated interferon plus ribavirin and highlighted issues related to management of patients with HIV/HCV co-infection. Although treatment for HCV infection in this group remains a challenge, achievement of a sustained virologic response is feasible in approximately 35% of patients. Treatment must be individualized and attention must be paid to the potential for drug-drug interactions.