Direct-acting Antivirals for HIV/HCV Co-infected Individuals: As Good as it Gets?

Although HIV/HCV co-infected individuals were historically considered a "difficult to treat" population in the era of Interferon (IFN)-based anti-HCV treatment, the introduction of directacting antivirals, characterized by excellent efficacy and good safety profile, has widely revolutionized the HCV treatment scenario. Recent real life studies reported excellent sustained virological response rates in HIV/HCV coinfected subjects, thus confirming data obtained in randomized clinical trials. However, certain issues have recently emerged in this population. In fact, high rates of acute HCV infection and reinfections were documented in several studies, particularly in HIV-positive men who have sex with men. Moreover, drug-drug interactions with ART or other co-medications may require careful considerations as well as the management of HIV/HCV co-infected subjects with chronic kidney disease and advanced liver disease in the course of a DAA-based treatment. Hence, we aim to review DAA efficacy studies performed in HIV/HCV co-infected patients in both randomized clinical trials and real-world cohorts. In addition, current challenges and future perspectives are discussed in order to optimize management strategies for HIV/HCV co-infected subjects and their access to care in clinical practice.