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HIV/HCV Coinfection: Current Challenges

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Viral Hepatitis: Chronic Hepatitis C

Abstract

Due to shared routes of transmission, prevalence of hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-infected patients is high.

It was previously observed that HIV/HCV-coinfected patients suffered from faster progression of liver fibrosis compared to HCV-mono-infected patients, resulting in increased rates of cirrhosis and decompensation of liver disease. However, over the past decade, the natural history of HIV/HCV coinfection has dramatically changed due to the correction of immune deficit in most patients due to the early introduction of safe and effective highly active antiretroviral therapy (HAART), the withdrawal of antiretroviral drugs with mitochondrial and liver toxicity from the combination antiretroviral therapy (cART) armamentarium, and the development of all-oral direct-acting antiviral (DAA) regimens. With a HCV cure rate in more than 95% of the patients, even those with severe fibrosis, it is now generally accepted that HIV-infected patients especially those who newly acquire HCV have the same liver fibrosis progression rate as HCV-mono-infected individuals. Despite this, the risk of hepatocellular carcinoma (HCC) is not abolished in patients with severe fibrosis or cirrhosis before HCV cure especially in older patients and in those with a metabolic syndrome. Moreover, HIV/HCV-coinfected patients remain at higher risk of death from non-liver causes than HCV-mono-infected patients. Finally, HCV does not confer protective immunity; there remains an ongoing risk for reinfections underlining the need of a regular monitoring, in population at higher risk such as people who inject drugs (PWID) and high-risk men who have sex with men (MSM).

On Behalf of the ESCMID Study Group on Viral Hepatitis (ESGVH)

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Authors and Affiliations

  1. Infectious Diseases Department, Hôtel Dieu Hospital, University of Paris, Paris, France

    Dominique Salmon-Ceron

  2. Department of Internal Medicine, Infectious Diseases Section, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht, The Netherlands

    J. E. Arends & C. Leoni

  3. APHM, Aix-Marseille Univ U105, Laboratoire de Pharmacocinétique et Toxicologie, SMARTc CRCM Inserm UMR1068 CNRS UMR7258, Hôpital La Timone, Marseille, France

    C. Solas

  4. APHP, Hôpital Bichat-Claude Bernard, Laboratoire de Pharmaco-Toxicologie and IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité and INSERM, Paris, France

    G. Peytavin

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  4. C. Solas
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  5. G. Peytavin
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Correspondence to Dominique Salmon-Ceron .

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Editors and Affiliations

  1. ESCMID Study Group for Viral Hepatitis (ESGVH), Istanbul, Turkey

    Resat Ozaras

  2. Infectious Diseases Department, Hôtel Dieu Hospital, University of Paris, Paris, France

    Dominique Salmon-Ceron

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Salmon-Ceron, D., Arends, J.E., Leoni, C., Solas, C., Peytavin, G. (2019). HIV/HCV Coinfection: Current Challenges. In: Ozaras, R., Salmon-Ceron, D. (eds) Viral Hepatitis: Chronic Hepatitis C. Springer, Cham. https://doi.org/10.1007/978-3-030-03757-4_7

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  • DOI: https://doi.org/10.1007/978-3-030-03757-4_7

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  • Online ISBN: 978-3-030-03757-4

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