HIV/hepatitis C virus coinfection management: changing guidelines and changing paradigms

The aim of the study was to consider the impact of new direct-acting antiviral (DAA) regimens on hepatitis C virus (HCV) treatment in HIV/HCV coinfection.

Current coinfection guidelines were reviewed and the impact of recent DAA publications evaluating HIV-coinfected individuals was considered.

Current coinfection guidelines recommend HIV antiretroviral therapy initiation prior to HCV antiviral therapy. New all-oral, combination antiviral therapy composed of one or more DAAs with or without ribavirin will change this paradigm. As these regimens are better tolerated, it will be possible to offer nearly all HCV-infected patients antiviral therapy, including those with HIV infection. All-oral regimens may impact the incidence of HCV infection by providing a treatment option that can be safely and broadly utilized in high-risk populations with the benefits of curing individual patients and addressing broader public health concerns related to HCV.

HCV infection treatment should no longer be a secondary consideration restricted to the minority of HIV/HCV-coinfected patients.