Options for treatment of hepatitis C in HIV-infected persons

Irrespective of whether a patient has HIV infection, the optimal treatment for hepatitis C virus (HCV) infection is peginterferon alpha and ribavirin. In both HIV-infected and uninfected persons, sustained virologic response (SVR) rates are higher for genotype 2 and genotype 3 HCV infection and for patients with lower pre-treatment HCV RNA levels. HIV-infection does not alter either the reality that persons who fail to achieve a 2 log10 reduction in HCV RNA level after 12 weeks of therapy rarely achieve a SVR, or the theoretical benefits of maintenance therapy in those without viral responses. The same adverse treatment effects can occur in HIV-infected and uninfected persons, but treatment of HIV-infected persons is complicated by interactions between ribavirin and antiretroviral medications and effects of HCV treatment on the course of HIV. The optimal treatment doses and durations are not known for HIV-infected persons, who are also less likely to achieve a SVR. A final difference is that the benefits of HCV treatment breakthroughs are usually realized in patients without HIV years before those with HIV. Future research must focus both on improving outcomes with currently available medications and rapidly evaluating the safety and efficacy of forthcoming antiviral compounds in HIV/HCV coinfected persons.