Hepatitis C virus infection in the human immunodeficiency virus infected patient

Louise Nygaard Clausen1, Lene Fogt Lundbo1, Thomas Benfield1

  • 1Louise Nygaard Clausen, Lene Fogt Lundbo, Thomas Benfield, Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, 2650 Hvidovre, Denmark.

Insights

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection is common, with liver disease now causing more deaths than AIDS. New direct-acting antiviral agents offer improved HCV cure rates for coinfected individuals.

Area of Science:

  • Hepatology
  • Infectious Diseases
  • Virology

Background:

  • Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) share transmission routes, leading to frequent coinfection, particularly in the Western world, affecting millions.
  • Injection drug use is the primary HCV transmission route, but sexual transmission among men who have sex with men is increasing.
  • Liver-related mortality now exceeds AIDS-related mortality in HIV-HCV coinfected individuals due to effective antiretroviral therapy.

Purpose of the Study:

  • To review the epidemiology, diagnosis, and natural history of HCV infection in HIV-HCV coinfected individuals.
  • To discuss current and future therapeutic strategies for HCV in the context of HIV coinfection.
  • To highlight the evolving landscape of HCV treatment and its impact on coinfected populations.

Main Methods:

  • Literature review focusing on epidemiology, diagnosis, natural history, and treatment of HCV in HIV-coinfected individuals.
  • Analysis of current direct-acting antiviral (DAA) therapies and their efficacy.
  • Exploration of future treatment paradigms and challenges.

Main Results:

  • HCV infection incidence peaked in the mid-1980s, with slow progression to cirrhosis in 15-20% of cases over 15-20 years.
  • Direct-acting antiviral agents have significantly improved HCV cure rates by targeting viral life cycle components.
  • Effective antiretroviral therapy for HIV has shifted mortality causes towards liver disease in coinfected patients.

Conclusions:

  • HIV-HCV coinfection presents a significant public health challenge, with increasing liver-related morbidity and mortality.
  • Current DAA therapies offer high cure rates for HCV, transforming treatment outcomes.
  • Future strategies must address sustained virologic response, potential drug resistance, and long-term liver disease management in coinfected individuals.

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