Hepatitis C virus and human immunodeficiency virus coinfection: where do we stand?

Both human immunodeficiency virus (HIV) and hepatitis C (HCV) are globally infecting millions of people. Since these viruses are both transmitted through blood-blood contact the rate of coinfection is as high as 30% and among i.v. drug users in the Western world 70%. In The Netherlands, 8% of HCV-infected patients are coinfected with HIV. After the successful introduction of antiretroviral therapy (HAART) the survival of patients with HIV has increased considerably. Coinfection leads to accelerated progression of liver cirrhosis and liver failure but conflicting evidence exists about the effect of HCV on the natural course of HIV. Four randomised controlled trials have shown that treatment with pegylated interferon plus ribavirin leads to an overall sustained viral response (SVR) rate between 27 and 44%. Divided by genotype the SVR is between 14 and 38% in genotype 1 (and 4) while between 53 and 73% for genotype 2 and 3. These percentages are calculated based on an intention-to-treat analysis. Although lower than in HCV-monoinfected patients this is much higher than achieved with conventional interferon. However, coinfected patients with genotypes 2 and 3 also need to be treated for 48 weeks in contrast to monoinfected patients. As the number and severity of side effects is low, coinfected patients now have a substantially better option for treatment.