Management issues in patients coinfected with hepatitis C virus and HIV.

Coinfection with HIV accelerates the progression of hepatitis C toward advanced liver disease. Low CD4+ cell counts may result in false-negative results on all diagnostic tests except hepatitis C virus (HCV) RNA assays, which are the gold standard for viral replication. First-line management of HIV-HCV--coinfected patients should be optimization of HAART, because low CD4+ cell counts have been associated with greater fibrosis. In addition, agents used to treat hepatitis C may lower CD4+ cell counts and hemoglobin levels. Long-acting interferons offer the promise of better sustained HCV response in HIV-HCV coinfection.