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Management and treatment of chronic hepatitis C in HIV patients

Pablo Barreiro1, Eugenia Vispo, Pablo Labarga

  • 1Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain.

Seminars in Liver Disease
|July 5, 2012
PubMed

Insights

Direct-acting antivirals (DAA) offer new hope for chronic hepatitis C (HCV) in HIV patients, but drug interactions and cost pose challenges. Personalized treatment using noninvasive tools and pharmacogenomics can improve outcomes.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Virology

Background:

  • Chronic hepatitis C (HCV) progresses faster to cirrhosis in human immunodeficiency virus (HIV)-coinfected patients.
  • HCV/HIV coinfection shows lower response rates to peginterferon/ribavirin therapy compared to HCV monoinfection.
  • Antiretroviral therapy may improve outcomes, but standard treatments remain suboptimal.

Purpose of the Study:

  • To review the challenges and potential strategies for treating chronic hepatitis C in HIV-coinfected patients using direct-acting antivirals (DAA).

Main Methods:

  • Review of current literature on HCV/HIV coinfection treatment.
  • Discussion of DAA therapy challenges, including drug interactions, adherence, resistance, and cost.
  • Exploration of personalized treatment approaches.

Main Results:

  • DAA therapy is eagerly awaited but presents challenges like drug interactions with antiretrovirals and potential for resistance.
  • High costs and adherence issues due to polymedication are significant concerns.
  • Noninvasive fibrosis assessment (elastometry) and pharmacogenomics (IL28B, ITPA) can guide individualized DAA treatment.

Conclusions:

  • Personalized treatment strategies incorporating noninvasive tools and pharmacogenomics are crucial for optimizing DAA therapy in HIV/HCV coinfected patients.
  • Addressing drug interactions, adherence, and cost is essential for successful DAA implementation.
  • Individualized approaches can improve cost-effectiveness and therapeutic outcomes.

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