Hepatitis C Management in Patients with Hepatitis C and HIV Co-infection

Co-infection with HIV and hepatitis C (HCV) is common due to similar risk factors. Twenty-five to thirty percent of HIV+ patients are co-infected with HCV. HCV infection in HIV+ patients is associated with higher rates of fibrosis, progression to cirrhosis and decompensated liver disease, and liver-related mortality. The ultimate HCV treatment goal is viral eradication, or sustained virologic response (SVR) which results in decreased liver-related morbidity and mortality. Prior therapies were suboptimal in co-infected patients. However, the new HCV direct-acting antiviral agents provide excellent treatment options in co-infected patients with response rates and adverse events similar to the HCV mono-infected population. Drug interactions between HIV treatments and HCV treatments can be challenging and must be taken into consideration. To optimize outcomes, co-infected patients should be managed by experienced providers or in the setting of a collaborative multidisciplinary approach. This article will review the current treatment rationale and recommendations for HIV-HCV-co-infected patients.