Skip to main content
Log in

Hepatitis C virus infection in HIV-infected patients

  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

The hepatitis C virus (HCV) is a spherical enveloped RNA virus of the Flaviviridae family, classified within the Hepacivirus genus. Since its discovery in 1989, HCV has been recognized as a major cause of chronic hepatitis and hepatic fibrosis that progresses in some patients to cirrhosis and hepatocellular carcinoma. In the United States, approximately 4 million people have been infected with HCV, and 10,000 HCVrelated deaths occur each year. Due to shared routes of transmission, HCV and HIV co-infection are common, affecting approximately one third of all HIV-infected persons in the United States. In addition, HIV co-infection is associated with higher HCV RNA viral load and a more rapid progression of HCV-related liver disease, leading to an increased risk of cirrhosis. HCV infection may also impact the course and management of HIV disease, particularly by increasing the risk of antiretroviral drug-induced hepatotoxicity. Thus, chronic HCV infection acts as an opportunistic disease in HIV-infected persons because the incidence of infection is increased and the natural history of HCV infection is accelerated in co-infected persons. Strategies to prevent primary HCV infection and to modify the progression of HCV-related liver disease are urgently needed among HIV/HCV co-infected individuals.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Centers for Disease Control and Prevention: 1999 USPHS/ IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: disease-specific recommendations. USPHS/ IDSA Prevention of Opportunistic Infections Working Group. US Public Health Services/Infectious Diseases Society of America. MMWR 1999, 48:1–82. Guidelines consider management of HCV in HIV-positive patients.

    Google Scholar 

  2. Choo QL, Richman KH, Han JH, et al. Genetic organization and diversity of the hepatitis C virus. Proc Natl Acad Sci U S A 1991, 88:2451–2455.

    Article  PubMed  CAS  Google Scholar 

  3. Neumann AU, Lam NP, Dahari H, et al. Hepatitis C viral dynamics in vivo and the antiviral efficacy of interferon-alpha therapy. Science 1998, 282:103–107.

    Article  PubMed  CAS  Google Scholar 

  4. Ogata N, Alter HJ, Miller RH, Purcell RH, Nucleotide sequence and mutation rate of the H strain of hepatitis C virus. Proc Natl Acad Sci U S A 1991, 88:3392–3396.

    Article  PubMed  CAS  Google Scholar 

  5. Abe K, Inchauspe G, Fujisawa K, Genomic characterization and mutation rate of hepatitis C virus isolated from a patient who contracted hepatitis during an epidemic of non-A, non-B hepatitis in Japan. J Gen Virol 1992, 73:2725–2729.

    Article  PubMed  CAS  Google Scholar 

  6. Stuyver L, Rossau R, Wyseur A, et al. Typing of hepatitis C virus isolates and characterization of new subtypes using a line probe assay. J Gen Virol 1993, 74:1093–1102.

    Article  PubMed  CAS  Google Scholar 

  7. Donahue JG, Munoz A, Ness PM, et al. The declining risk of post-transfusion hepatitis C virus infection. N Engl J Med 1992, 327:369–373.

    Article  PubMed  CAS  Google Scholar 

  8. Schreiber GB, Busch MP, Kleinman SH, Korelitz JJ, The risk of transfusion-transmitted viral infections. The Retrovirus Epidemiology Donor Study. N Engl J Med 1996, 334:1685–1690.

    Article  PubMed  CAS  Google Scholar 

  9. Thomas DL, Vlahov D, Solomon L, et al. Correlates of hepatitis C virus infections among injection drug users in Baltimore. Medicine 1995, 74:212–220.

    Article  PubMed  CAS  Google Scholar 

  10. Alter MJ, Hadler SC, Judson FN, et al. Risk factors for acute non-A, non-B hepatitis in the United States and association with hepatitis C virus infection. JAMA 1990, 264:2231–2235.

    Article  PubMed  CAS  Google Scholar 

  11. Villano SA, Vlahov D, Nelson KE, et al. Incidence and risk factors for hepatitis C among injection drug users in Baltimore, Maryland. J Clin Microbiol 1997, 35:3274–3277.

    PubMed  CAS  Google Scholar 

  12. Van Ameijden EJ, van den Hoek JA, Mientjes GH, Coutinho RA, A longitudinal study on the incidence and transmission patterns of HIV, HBV and HCV infection among drug users in Amsterdam. Eur J Epidemiol 1993, 9:255–262.

    Article  PubMed  Google Scholar 

  13. Centers for Disease Control and Prevention: Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998, 47,No. RR-19,:1–39.

    Google Scholar 

  14. Thomas DL, Zenilman JM, Alter HJ, et al. Sexual transmission of hepatitis C virus among patients attending sexually transmitted diseases clinics in Baltimore: an analysis of 309 sex partnerships. J Infect Dis 1995, 171:768–775.

    PubMed  CAS  Google Scholar 

  15. Conry-Cantilena C, Vanraden MT, Gibble J, et al. Routes of infection, viremia, and liver disease in blood donors found to have hepatitis C virus infection. N Engl J Med 1996, 334:1691–1696.

    Article  PubMed  CAS  Google Scholar 

  16. Everhart JE, Di Bisceglie AM, Murray LM, et al. Risk for non-A, non-B (type C) hepatitis through sexual or household contact with chronic carriers. Ann Intern Med 1990, 112:544–545.

    PubMed  CAS  Google Scholar 

  17. Gordon SC, Patel AH, Kulesza GW, et al. Lack of evidence for the heterosexual transmission of hepatitis C. Am J Gastroenterol 1992, 87:1849–1851.

    PubMed  CAS  Google Scholar 

  18. Brettler DB, Mannucci PM, Gringeri A, et al. The low risk of hepatitis C virus transmission among sexual partners of hepatitis C-infected hemophilic males: an international, multicenter study. Blood 1992, 80:540–543.

    PubMed  CAS  Google Scholar 

  19. Osmond DH, Padian NS, Sheppard HW, et al. Risk factors for hepatitis C virus seropositivity in heterosexual couples. JAMA 1993, 269:361–365.

    Article  PubMed  CAS  Google Scholar 

  20. Thomas DL, Villano SA, Riester KA, et al. Perinatal transmission of hepatitis C virus from human immunodeficiency virus type 1-infected mothers. J Infect Dis 1998, 177:1480–1488.

    Article  PubMed  CAS  Google Scholar 

  21. Zanetti AR, Tanzi E, Paccagnini S, et al. Mother-to-infant transmission of hepatitis C virus. Lancet 1995, 345:289–291.

    Article  PubMed  CAS  Google Scholar 

  22. Sulkowski MS, Mast EE, Seeff LB, Thomas DL, Hepatitis C virus infection as an opportunistic disease in persons infected with human immunodeficiency virus. Clin Infect Dis 2000, 30,suppl 1,:S77-S84. Good review paper of HCV infection as an opportunistic disease in HIV-infected persons.

    Article  PubMed  Google Scholar 

  23. Makris M, Preston FE, Triger DR, et al. Hepatitis C antibody and chronic liver disease in haemophilia. Lancet 1990, 335:1117–1119.

    Article  PubMed  CAS  Google Scholar 

  24. Donahue JG, Nelson KE, Munoz A, et al. Antibody to hepatitis C virus among cardiac surgery patients, homosexual men, and intravenous drug users in Baltimore, Maryland. Am J Epidemiol 1991, 134:1206–1211.

    PubMed  CAS  Google Scholar 

  25. Alter MJ, Margolis HS, Krawczynski K, et al. The natural history of community acquired hepatitis C in the United States. N Engl J Med 1992, 327:1899–1905.

    PubMed  CAS  Google Scholar 

  26. Tong MJ, El-Farra NS, Reikes AR, Co RL, Clinical outcomes after transfusion-associated hepatitis C. N Engl J Med 1995, 332:1463–1466.

    Article  PubMed  CAS  Google Scholar 

  27. Seeff LB, Buskell-Bales ZB, Wright EC, et al. Long-term mortality after transfusion-associated non-A, non-B hepatitis. N Engl J Med 1992, 327:1906–1911.

    PubMed  CAS  Google Scholar 

  28. Kenny-Walsh E, Clinical outcomes after hepatitis C infection from contaminated anti-D immune globulin. Irish Hepatology Research Group. N Engl J Med 1999, 340:1228–1233.

    Article  PubMed  CAS  Google Scholar 

  29. Fattovich G, Giustina G, Degos F, et al. Morbidity and mortality in compensated cirrhosis C: a follow-up study of 384 patients. Gastroenterology 1997, 112:463–472.

    Article  PubMed  CAS  Google Scholar 

  30. Thomas DL, Astemborski J, Rai RM, et al. The natural history of hepatitis C virus infection: host, viral, and environmental factors. JAMA 2000, 284:450–456.

    Article  PubMed  CAS  Google Scholar 

  31. Thomas DL, Astemborski J, Vlahov D, et al. Determinants of the quantity of hepatitis C virus RNA. J Infect Dis 2000, 181:844–851.

    Article  PubMed  CAS  Google Scholar 

  32. Thomas DL, Shih JW, Alter HJ, et al. Effect of human immunodeficiency virus on hepatitis C virus infection among injecting drug users. J Infect Dis 1996, 174:690–695.

    PubMed  CAS  Google Scholar 

  33. Telfer P, Sabin C, Devereux H, et al. The progression of HCV-associated liver disease in a cohort of hemophiliac patients. Br J Haematol 1994, 87:555–561.

    Article  PubMed  CAS  Google Scholar 

  34. Sherman KE, O’Brien J, Gutierrez AG, et al. Quantitative evaluation of hepatitis C virus RNA in patients with concurrent human immunodeficiency virus infections. J Clin Microbiol 1993, 31:2679–2682.

    PubMed  CAS  Google Scholar 

  35. Eyster ME, Fried MW, Di Bisceglie AM, Goedert JJ, Increasing hepatitis C virus RNA levels in hemophiliacs: relationship to human immunodeficiency virus infection and liver disease. Blood 1994, 84:1020–1023.

    PubMed  CAS  Google Scholar 

  36. Eyster ME, Diamondstone LS, Lien JM, et al. Natural history of hepatitis C virus infection in multitransfused hemophiliacs: effect of coinfection with human immunodeficiency virus. The Multicenter Hemophilia Cohort Study. J Acquir Immune Defic Syndr 1993, 6:602–610.

    PubMed  CAS  Google Scholar 

  37. Darby SC, Ewart DW, Giangrande PL, et al. Mortality from liver cancer and liver disease in haemophilic men and boys in UK given blood products contaminated with hepatitis C. Lancet 1997, 350:1425–1431.

    Article  PubMed  CAS  Google Scholar 

  38. Lesens O, Deschenes M, Steben M, et al. Hepatitis C virus is related to progressive liver disease in human immunodeficiency virus-positive hemophiliacs and should be treated as an opportunistic infection. J Infect Dis 1999, 179:1254–1258.

    Article  PubMed  CAS  Google Scholar 

  39. Pol S, Lamorthe B, Thi NT, et al. Retrospective analysis of the impact of HIV infection and alcohol use on chronic hepatitis C in a large cohort of drug users. J Hepatol 1998, 28:945–950.

    Article  PubMed  CAS  Google Scholar 

  40. Soriano V, Garcia-Samaniego J, Valencia E, et al. Impact of chronic liver disease due to hepatitis viruses as cause of hospital admission and death in HIV-infected drug users. Eur J Epidemiol 1999, 15:1–4.

    Article  PubMed  CAS  Google Scholar 

  41. Bica I, McGovern B, Dhar R, et al. Increasing mortality due to end-stage liver disease in patients with human immunodeficiency virus infection. Clin Infect Dis 2001, 32:492–497.

    Article  Google Scholar 

  42. Dorrucci M, Pezzotti P, Phillips AN, et al. Coinfection of hepatitis C virus with human immunodeficiency virus and progression to AIDS. J Infect Dis 1995, 172:1503–1508.

    PubMed  CAS  Google Scholar 

  43. Sulkowski MS, Moore RD, Mehta S, Thomas DL: Effect of HCV coinfection on HIV disease progression and survival in HIVinfected adults. Paper presented at 8th Conference on Retroviruses and Opportunistic Infections. February 4–8, 2001. Chicago.

  44. Piroth L, Duong M, Quantin C, et al. Does hepatitis C virus co-infection accelerate clinical and immunological evolution of HIV-infected patients? AIDS 1998, 12:381–388.

    Article  PubMed  CAS  Google Scholar 

  45. Greub G, Ledergerber B, Battegay M, et al. Clinical progression, survival, and immune recovery during antiretroviral therapy in patients with HIV-1 and hepatitis C virus coinfection: the Swiss HIV Cohort Study. Lancet 2000, 356:1800–1805. Study examines the effect of HCV on HIV outcome.

    Article  PubMed  CAS  Google Scholar 

  46. Brau N, Leaf HL, Wieczorek RL, Margolis DM, Severe hepatitis in three AIDS patients treated with indinavir. Lancet 1997, 349:924–925.

    Article  PubMed  CAS  Google Scholar 

  47. Arribas JR, Ibanez C, Ruiz-Antoran B, et al. Acute hepatitis in HIV-infected patients during ritonavir treatment. AIDS 1998, 12:1722–1724.

    PubMed  CAS  Google Scholar 

  48. Rodriguez-Rosado R, Garcia-Samaniego J, Soriano V, Hepatotoxicity after introduction of highly active antiretroviral therapy. AIDS 1998, 12:1256.

    Article  PubMed  CAS  Google Scholar 

  49. Sulkowski MS, Thomas DL, Chaisson RE, Moore RD, Hepatotoxicity associated with antiretroviral therapy in adults infected with human immunodeficiency virus and the role of hepatitis C or B virus infection. JAMA 2000, 283:74–80.

    Article  PubMed  CAS  Google Scholar 

  50. den Brinker M, Wit FW, Wertheim-van Dillen PM, et al. Hepatitis B and C virus co-infection and the risk for hepatotoxicity of highly active antiretroviral therapy in HIV-1 infection. AIDS 2000, 14:2895–2902.

    Article  Google Scholar 

  51. Ungo JR, Jones D, Ashkin D, et al. Antituberculosis druginduced hepatotoxicity. The role of hepatitis C virus and the human immunodeficiency virus. Am J Respir Crit Care Med 1998, 157:1871–1876.

    PubMed  CAS  Google Scholar 

  52. Vento S, Garofano T, Renzini C, et al. Enhancement of hepatitis C virus replication and liver damage in HIV-coinfected patients on antiretroviral combination therapy. AIDS 1998, 12:116–117.

    PubMed  CAS  Google Scholar 

  53. John M, Flexman J, French MAH, Hepatitis C virus-associated hepatitis following treatment of HIV-infected patients with HIV protease inhibitors: an immune restoration disease? AIDS 1998, 12:2289–2293.

    Article  PubMed  CAS  Google Scholar 

  54. Zylberberg H, Pialoux G, Carnot F, et al. Rapidly evolving hepatitis C virus-related cirrhosis in a human immunodeficiency virus-infected patient receiving triple antiretroviral therapy. Clin Infect Dis 1998, 27:1255–1258.

    Article  PubMed  CAS  Google Scholar 

  55. Thio CL, Nolt KR, Astemborski J, et al. Screening for hepatitis C virus in human immunodeficiency virus-infected individuals. J Clin Microbiol 2000, 38:575–577.

    PubMed  CAS  Google Scholar 

  56. Chamot E, Hirschel B, Wintsch J, et al. Loss of antibodies against hepatitis C virus in HIV-seropositive intravenous drug users. AIDS 1990, 4:1275–1277.

    Article  PubMed  CAS  Google Scholar 

  57. Mellors JW, Rinaldo CRJ, Gupta P, et al. Prognosis in HIV-1 infection predicted by the quantity of virus in plasma. Science 1996, 272:1167–1170.

    Article  PubMed  CAS  Google Scholar 

  58. Centers for Disease Control and Prevention: Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morbid Mortal Wkly Rep 1999, 48,RR-12,:1–54.

    Google Scholar 

  59. Vento S, Garofano T, Renzini C, et al. Fulminant hepatitis associated with hepatitis A virus superinfection in patients with chronic hepatitis C. N Engl J Med 1998, 338:286–290.

    Article  PubMed  CAS  Google Scholar 

  60. Fanning L, Kenny E, Sheehan M, et al. Viral load and clinicopathological features of chronic hepatitis C (1b) in a homogeneous patient population. Hepatology 1999, 29:904–907.

    Article  PubMed  CAS  Google Scholar 

  61. Perrillo RP, The role of liver biopsy in hepatitis C. Hepatology 1997, 26:57S-61S.

    Article  PubMed  CAS  Google Scholar 

  62. Poles MA, Dieterich DT, Schwarz ED, et al. Liver biopsy findings in 501 patients infected with human immunodeficiency virus (HIV). J Acquir Immune Defic Syndr Hum Retrovirol 1996, 11:170–177.

    PubMed  CAS  Google Scholar 

  63. National Institutes of Health consensus development conference panel statement: Management of hepatitis C. Hepatology 1997, 26:2S–10S.

  64. Soriano V, García-Samaniego J, Bravo R, et al. Interferon a for the treatment of chronic hepatitis C in patients infected with human immunodeficiency virus. Clin Infect Dis 1996, 23:585–591.

    PubMed  CAS  Google Scholar 

  65. Soriano V, Bravo R, García-Samaniego J, et al. Relapses of chronic hepatitis C in HIV-infected patients who responded to interferon therapy. AIDS 1997, 11:400–401.

    PubMed  CAS  Google Scholar 

  66. Effect of interferon-alpha on progression of cirrhosis to hepatocellular carcinoma: a retrospective cohort study, International Interferon-alpha Hepatocellular Carcinoma Study Group. Lancet 1998, 351:1535–1539.

    Article  Google Scholar 

  67. Nishiguchi S, Kuroki T, Nakatani S, et al. Randomised trial of effects of interferon-a on incidence of hepatocellular carcinoma in chronic active hepatitis C with cirrhosis. Lancet 1995, 346:1051–1055.

    Article  PubMed  CAS  Google Scholar 

  68. Nishiguchi S, Shiomi S, Nakatani S, et al. Prevention of hepatocellular carcinoma in patients with chronic active hepatitis C and cirrhosis. Lancet 2001, 357:196–197.

    Article  Google Scholar 

  69. Boyer N, Marcellin P, Degott C, et al. Recombinant interferonalpha for chronic hepatitis C in patients positive for antibody to human immunodeficiency virus. J Infect Dis 1992, 165:723–726.

    PubMed  CAS  Google Scholar 

  70. Marriott E, Navas S, Del Romero J, et al. Treatment with recombinant alpha-interferon of chronic hepatitis C in anti-HIV-positive patients. J Med Virol 1993, 40:107–111.

    Article  PubMed  CAS  Google Scholar 

  71. Poynard T, Marcellin P, Lee SS, et al. Randomised trial of interferon a2b plus ribavirin for 48 weeks or for 24 weeks versus interferon a2b plus placebo for 48 weeks for treatment of chronic infection with hepatitis C virus. Lancet 1998, 352:1426–1432.

    Article  PubMed  CAS  Google Scholar 

  72. McHutchison JG, Gordon SC, Schiff ER, et al. Interferon alfa-2b alone or in combination with ribavirin as initial treatment for chronic hepatitis C. N Engl J Med 1998, 339:1485–1492.

    Article  PubMed  CAS  Google Scholar 

  73. Landau A, Batisse D, Van Huyen JP, et al. Efficacy and safety of combination therapy with interferon-alpha2b and ribavirin for chronic hepatitis C in HIV-infected patients. AIDS 2000, 14:839–844.

    Article  PubMed  CAS  Google Scholar 

  74. Landau A, Batisse D, Piketty C, et al. Lack of interference between ribavirin and nucleosidic analogues in HIV/HCV co-infected individuals undergoing concomitant antiretroviral and anti-HCV combination therapy. AIDS 2000, 14:1857–1858.

    Article  PubMed  CAS  Google Scholar 

  75. Landau A, Batisse D, Piketty C, Kazatchkine MD, Effect of interferon and ribavirin on HIV viral load. AIDS 2000, 14:96–97.

    Article  PubMed  CAS  Google Scholar 

  76. Heathcote EJ, Shiffman ML, Cooksley WG, et al. Peginterferon alfa-2a in patients with chronic hepatitis C and cirrhosis. N Engl J Med 2000, 343:1673–1680.

    Article  PubMed  CAS  Google Scholar 

  77. Lindsay KL, Trepo C, Heintges T, et al. A randomized, double-blind trial comparing pegylated interferon alfa-2b to interferon alfa-2b as initial treatment for chronic hepatitis C. Hepatology 2001, 34:395–403.

    Article  Google Scholar 

  78. Manns MP, McHutchinson JG, Gordon S, et al. Peginterferon alfa-2b plus ribavirin compared to interferon alfa-2b plus ribavirin for the treatment of chronic hepatitis C: 24-week treatment analysis of a multicenter phase III randomized controlled trial [abstract 552]. Hepatology 2000, 32:297A.

    Article  Google Scholar 

  79. Dusheiko G, Side effects of alpha interferon in chronic hepatitis C. Hepatology 1997, 26:112S-121S.

    Article  PubMed  CAS  Google Scholar 

  80. Deutsch M, Dourakis S, Manesis EK, et al. Thyroid abnormalities in chronic viral hepatitis and their relationship to interferon alfa therapy. Hepatology 1997, 26:206–210.

    Article  PubMed  CAS  Google Scholar 

  81. Dieterich DT, et al.: Once-weekly recombinant human erythropoetin (epoetin alfa) facilitates optimal ribavirin (RBV) dosing in hepatitis C viurs (HCV)-infected patients receiving interferon-a-2b combination therapy [abstract 104956]. Gastroenterology 2001, In press.

  82. Vogt MW, Hartshorn KL, Furman PA, et al. Ribavirin antagonizes the effect of azidothymidine on HIV replication. Science 1987, 235:1376–1379.

    Article  PubMed  CAS  Google Scholar 

  83. Hoggard PG, Kewn S, Barry MG, et al. Effects of drugs on 2′,3′-dideoxy-2′,3′-didehydrothymidine phosphorylation in vitro. Antimicrob Agents Chemother 1997, 41:1231–1236.

    PubMed  CAS  Google Scholar 

  84. Baba M, Pauwels R, Balzarini J, et al. Ribavirin antagonizes inhibitory effects of pyrimidine 2′,3′-dideoxynucleosides but enhances inhibitory effects of purine 2′,3′-dideoxynucleosides on replication of human immunodeficiency virus in vitro. Antimicrob Agents Chemother 1987, 31:1613–1617.

    PubMed  CAS  Google Scholar 

  85. Lafeuillade A, Hittinger G, Chadapaud S, Increased mitochondrial toxicity with ribavirin in HIV/HCV coinfection. Lancet 2001, 357:280–281.

    Article  Google Scholar 

  86. Japour AJ, Lertora JJ, Meehan PM, et al. A phase-I study of the safety, pharmacokinetics, and antiviral activity of combination didanosine and ribavirin in patients with HIV-1 disease. AIDS Clinical Trials Group 231 Protocol Team. J Acquir Immune Defic Syndr Hum Retrovirol 1996, 13:235–246.

    PubMed  CAS  Google Scholar 

  87. Zylberberg H, Benhamou Y, Lagneaux JL, et al. Safety and efficacy of interferon-ribavirin combination therapy in HCV-HIV coinfected subjects: an early report. Gut 2000, 47:694–697.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sulkowski, M.S. Hepatitis C virus infection in HIV-infected patients. Curr Infect Dis Rep 3, 469–476 (2001). https://doi.org/10.1007/BF03160472

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03160472

Keywords

Navigation