Antiviral drugs and the treatment of hepatitis C

Area of Science:

• Infectious Diseases
• Hepatology
• Virology

Background:

• Hepatitis C virus (HCV) is a significant cause of illness and death in people with HIV-1, especially those with low CD4 counts.
• HIV/HCV co-infection accelerates liver disease progression, including cirrhosis.
• HCV treatment is a priority, but managing co-infections presents challenges.

Purpose of the Study:

• To review data on optimizing antiretroviral therapy (ART) regimens in HIV/HCV co-infected patients before initiating HCV treatment.
• To enhance the likelihood of achieving sustained virologic response (SVR) to HCV therapy.
• To address challenges posed by drug-drug interactions (DDIs) and overlapping adverse events.

Main Methods:

• Literature review focusing on studies concerning ART optimization in HIV/HCV co-infected individuals.
• Analysis of data on DDIs between ART and HCV treatment regimens (pegylated interferon, ribavirin, protease inhibitors).
• Evaluation of strategies to mitigate overlapping drug-associated adverse events.

Main Results:

• Specific ART regimens can be optimized prior to HCV treatment to minimize DDIs.
• Careful selection of ART can reduce the risk of adverse events during HCV therapy.
• Optimized ART strategies are associated with an increased chance of achieving SVR.

Conclusions:

• Optimizing ART before HCV treatment is essential for successful outcomes in HIV/HCV co-infected patients.
• Managing DDIs and adverse events through ART selection is key to improving SVR rates.
• This review provides guidance for clinicians on selecting appropriate ART regimens.