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Treatment of chronic hepatitis C in patients with HIV/HCV coinfection

Nicola Coppola1, Salvatore Martini1, Mariantonietta Pisaturo1

  • 1Nicola Coppola, Salvatore Martini, Mariantonietta Pisaturo, Pietro Filippini, Evangelista Sagnelli, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy.

World Journal of Virology
|February 13, 2015
PubMed

Insights

Hepatitis C virus (HCV) infection is a major concern in the human immunodeficiency virus (HIV) population. Newer direct-acting antivirals (DAAs) offer improved efficacy and tolerability for treating HCV in coinfected patients.

Area of Science:

  • Hepatology
  • Virology
  • Infectious Diseases

Background:

  • Hepatitis C virus (HCV) infection significantly increases comorbidity and mortality in human immunodeficiency virus (HIV)-positive individuals.
  • Liver-related mortality is the second leading cause of death in the HIV-positive population, underscoring the need for effective HCV antiviral therapy.

Purpose of the Study:

  • To review the evolution and impact of direct-acting antivirals (DAAs) in treating Hepatitis C virus (HCV) infection, particularly in coinfected HIV/HCV patients.
  • To evaluate the efficacy, tolerability, and adherence of first-generation and newer DAAs in managing HCV in the context of HIV coinfection.

Main Methods:

  • Review of the literature on antiviral therapies for HCV infection, focusing on the introduction and progression of DAAs.
  • Analysis of treatment outcomes, including sustained virological response, tolerability, and adherence, for different DAA generations in HCV-monoinfected and HIV/HCV coinfected patients.

Main Results:

  • First-generation DAAs (telaprevir, boceprevir) combined with pegylated interferon alfa (Peg-IFN) + ribavirin (RBV) improved sustained virological response rates in HCV genotype 1, including coinfected patients.
  • While effective, first-generation DAAs presented challenges with tolerability and adherence due to high pill burden and drug interactions with antiretroviral therapy.
  • Second and third-generation DAAs, including interferon-free regimens, have demonstrated high efficacy, good tolerability, low pill burden, and shorter treatment durations, with promising preliminary results in HIV-positive patients.

Conclusions:

  • Direct-acting antivirals have revolutionized HCV treatment, offering significant improvements over older therapies.
  • Newer generations of DAAs are particularly beneficial for HIV/HCV coinfected patients, enhancing treatment efficacy, tolerability, and adherence, with interferon-free regimens showing particular promise.

Keywords:
Anti-hepatitis C virus treatmentChronic hepatitis CDirectly acting antiviralsHIV/HCV coinfectionHepatitis C virus infectionHuman immunode-ficiency virus infection

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