HIV/HCV Coinfection: Sustained Viral Response Possible and Likely

March 1, 2017

Jeannette Y. Wick, RPh, MBA, FASCP

Article

Up to 30% of people who have HIV, and more than 80% of HIV-positive injection drug users also have hepatitis C virus (HCV) as well.

Up to 30% of people who have HIV, and more than 80% of HIV-positive injection drug users also have hepatitis C virus (HCV) as well. HIV/HCV coinfection complicates disease management, accelerates liver damage, and can be a challenge to manage.

For the past few years, several direct acting antivirals (DAAs) have been available. For the patient with hepatitis C-infected who does not have HIV, these drugs have been life saving and curative in almost all patients. Researchers have wondered if DAAs could similarly cure HCV in HIV-infected patients.

A review piece from a Medical University of South Carolina researcher noted that health care providers dealing with patients with HIV are witnessing treatment success in HIV/HCV coinfected individuals with the use of DAAs. More than 90% of HIV/HCV coinfected patients achieve sustained virologic responses.

Ideally, relative efficacy would drive selection of a DAA. However, in HIV, DAA selection is driven by several factors: medication access, insurance formulary preferences, and drug—drug compatibility, according to the review author.

Clinicians need to be ever-vigilant for potential drug—drug interactions between HCV and HIV medications. Statins and acid-suppressing agents are also prone to interact with DAAs.

Most health care providers recognize preventing hepatic decompensation and hepatocellular cancer are the most pressing reasons to treat HCV. Research now shows that treating HIV/HCV coinfected patients with early liver disease lowers health care utilization during the next 5 years.

The author concluded that the health care community needs to determine the best approach to resolve the overlapping epidemics of opiate use, mass incarceration, and HIV—HCV infections.

This review appeared in Current Opinion in Gastroenterology.

Reference

Meissner EG. Update in HIV-hepatitis C virus coinfection in the direct acting antiviral era. Curr Opin Gastroenterol. 2017 Feb 23. doi: 10.1097/MOG.0000000000000347. [Epub ahead of print]