Hepatitis C Treatment in HIV Coinfection: Approaches, Challenges, and Future Opportunities

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) coinfection is a significant cause of morbidity and mortality in people living with HIV/AIDS. Indeed, HCV is more likely to progress to end-organ dysfunction in HIV-infected people, and fibrosis progresses more quickly in this population than in the general population. While historical treatments combining interferon and ribavirin were less efficacious in HIV/HCV coinfection, modern direct-acting antiviral (DAA) therapies have shown similar clinical efficacy in HIV/HCV coinfection as in HCV monoinfection. In light of these findings, HIV/HCV-coinfected patients may benefit even more from new HCV treatment approaches. The choice of DAA therapy for HCV in HIV-infected patients should be based on the patient’s disease stage, prior treatment history, and viral characteristics such as genotype and/or resistance mutations, just as it is in patients with HCV monoinfection. Potential drug-drug interactions between HIV antiretroviral therapy (ART) and HCV DAA therapy must be considered when prescribing HCV treatment and may impact the choice of treatment. Caution is advised when considering DAA regimens that have not been studied in HIV/HCV populations due to lack of data regarding efficacy, the potential for drug-drug interactions, or both. In the era of DAA therapy and with many therapeutic options available to tailor appropriate regimens in order to avoid drug-drug interactions, HCV should be treated aggressively in HIV-infected persons to reduce morbidity and mortality.