Epidemiology of hepatitis C virus in HIV-infected patients

This review will give an update on the prevalence of HIV/hepatitis C virus (HCV) coinfection, and describe recent trends in all-cause and cause-specific mortality. The focus is mainly on patients followed in clinics in high-income countries and their heterogeneity in terms of risk factors and clinical outcomes.

In countries that have introduced comprehensive preventive strategies for injection drug users, the prevalence of HIV/HCV coinfection has declined. Compared with HIV monoinfected patients, the mortality among HCV-coinfected patients remains markedly increased because of multiple risk factors, in particular among drug users. The spectrum of causes of death among coinfected has recently been described in large cohort studies. Around a quarter of all deaths were liver related, and the incidence has decreased in Western Europe and stabilized in Eastern Europe where AIDS remains the dominant cause of death. In North America, the incidence of end-stage liver disease has not decreased despite improvements in HIV care. HCV treatment seems to have had little effect thus far on mortality at the population level.

Despite a decreasing prevalence of HIV/HCV coinfection in many countries, coinfection remains an important clinical problem that requires a multidisciplinary approach including direct-acting antivirals for those at risk of liver-related death.