Management of chronic hepatitis C virus infection in HIV-infected patients.

The management of chronic hepatitis C virus infection in patients coinfected with the human immunodeficiency virus poses a significant challenge. Treatment is influenced by a number of viral and host characteristics, including hepatitis C virus genotype, baseline viremia, and adherence to medication regimen. Accelerated progression of liver disease, immunodeficiency, and hepatotoxicity of antiretroviral drugs are additional concerns in coinfected patients. According to the results of 5 randomized clinical trials, 27%-55% of coinfected patients who received therapy with pegylated interferon-alpha and ribavirin attained a sustained virologic response. These studies also confirm the importance of early virologic response as a predictor of treatment outcome and reveal the considerable proportion of patients who experience hematologic tolerability issues. Effective management strategies that encompass patient and viral factors are necessary to improve the long-term outlook for coinfected patients.