Treatment of HCV in HIV/HCV Coinfection: What Are the New Questions?

there are a number of potential benefits tied to the treatment of chronic hepatitis C virus (hcv) infection in hiv-infected individuals. The most desired outcome of treatment—which is possible in both hcv-monoinfected and hiv/hcv-coinfected patients—is viral eradication. Additional but unproven benefits of anti-hcv therapy may be a reduction in inflammatory hepatic damage with regression of fibrosis and/or the risk of hepatocellular carcinoma, or to improve tolerability of antiretrovirals. There is also the public health component of hcv treatment: to render patients aviremic, thus reducing their chances of passing the virus on to others. Over the past year, the results of several pivotal studies evaluating pegylated interferon and ribavirin—the standard-of-care drug combination for the treatment of chronic hepatitis C—in hiv/hcv-coinfected patients have been completed and published. Across the board, the results were encouraging, illustrating a clear-cut therapeutic advantage of pegylated interferon and ribavirin over conventional interferon-alfa and ribavirin. However, there are important design and population differences between the studies, raising some questions as to how best to translate these data into clinical practice.