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Published on: September 30, 2021

Management of HCV-related end-stage liver disease in HIV-coinfected patients

Nicolás Merchante1, Manuel Jiménez-Saenz, Juan A Pineda

  • 1Unit of Infectious Diseases, Hospital Universitario de Valme, Seville, Spain.

AIDS Reviews
|November 7, 2007
PubMed

Insights

Managing end-stage liver disease in patients with HIV and hepatitis C virus (HCV) coinfection presents unique challenges. Cirrhosis decompensation differs in coinfected individuals, with ascites and hepatic encephalopathy being more common, and liver transplantation is a crucial early consideration.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • HIV Medicine

Background:

  • Hepatitis C virus (HCV) infection is a significant contributor to end-stage liver disease, posing a major clinical challenge for patients coinfected with human immunodeficiency virus (HIV).
  • Effective management of cirrhosis and its complications in HIV/HCV-coinfected individuals requires a nuanced understanding of their distinct clinical presentation.

Purpose of the Study:

  • To review the diagnosis and management strategies for cirrhosis and its complications in the context of HIV/HCV coinfection.
  • To highlight the differences in clinical presentation and management of cirrhosis decompensation in coinfected patients compared to HCV-monoinfected individuals.

Main Methods:

  • Review of current literature on the diagnosis and management of cirrhosis in HIV/HCV-coinfected patients.
  • Discussion of noninvasive diagnostic methods, clinical profiles of decompensation, and emerging treatment options.

Main Results:

  • Noninvasive diagnostic tools like biomarkers and transient hepatic elastography are valuable for assessing cirrhosis.
  • Cirrhosis decompensation in HIV/HCV coinfection frequently manifests as ascites and hepatic encephalopathy, with hepatocellular carcinoma being less common in the absence of hepatitis B virus (HBV) coinfection.
  • Liver transplantation is a viable treatment option and should be considered early due to high mortality post-decompensation.

Conclusions:

  • Early consideration of liver transplantation is critical for improving outcomes in HIV/HCV-coinfected patients with end-stage liver disease.
  • The clinical course and management of cirrhosis in coinfected patients necessitate tailored approaches distinct from HCV-monoinfected populations.

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