Coinfection with HIV and HCV: more questions than answers?

Chronic infection with the hepatitis C virus (HCV) is a major public health threat in the United States and worldwide. By sharing some routes of transmission, persons infected with the human immunodeficiency virus (HIV) are at risk for coinfection with HCV As a result, hepatic cirrhosis, end-stage liver disease, and hepatocellular carcinoma due to chronic infection with HCV are important causes of both morbidity and mortality in coinfected patients. The advent of highly active antiretroviral therapy improved the management of patients with HIV, leading to decreased morbidity and better survival. As patients infected with HIV live longer, their risk of long-term sequelae from chronic HCV increases. Coinfection with HIV may be associated with rapid progression of chronic HCV. In contrast, the effect of HCV on the natural history of HIV is less clear. Data regarding treatment of HCV in HIV-coinfected patients are limited.