ABSTRACT Infection with HCV is common in HIV-infected patients and is an increasingly important public health problem. The medical management of hepatitis C in HIV-infected patients is

complicated by immune suppression, potential drug interactions and toxicities, and the relative paucity of health-care providers with expertise in the management of both diseases.

Nonetheless, there are now data to support the safety, tolerability and efficacy of hepatitis C treatment with peginterferon plus ribavirin in HIV-infected patients, and the impetus to treat

these patients is, therefore, strong. Although the standard of care for the treatment of hepatitis C in HIV-infected patients has been more clearly defined, the delivery of care for

management of HCV infection in HIV-infected patients. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS

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access 25 February 2021 REAL-WORLD TREATMENT OUTCOME OF DIRECT-ACTING ANTIVIRALS AND PATIENT SURVIVAL RATES IN CHRONIC HEPATITIS C VIRUS INFECTION IN ERITREA Article Open access 27 November

2023 REAL-WORLD EFFICACY AND SAFETY OF PANGENOTYPIC DIRECT-ACTING ANTIVIRALS AGAINST HEPATITIS C VIRUS INFECTION IN TAIWAN Article Open access 29 June 2021 REFERENCES * Sulkowski MS et al.

(2002) Hepatitis C and progression of HIV disease. _JAMA_ 288: 199–206 Article  Google Scholar  * Sherman KE et al. (2000) Hepatitis C prevalence in HIV-infected patients: a cross-sectional

analysis of the US adult clinical trials group. _Antiviral Ther_ 5 (Suppl 1): S64 Google Scholar  * Amin J et al. (2004) HIV and hepatitis C coinfection within the CAESAR study. _HIV Med_ 5:

174–179 Article  CAS  Google Scholar  * Rosenthal E et al. (2003) Mortality due to hepatitis C-related liver disease in HIV-infected patients in France (Mortavic 2001 study). _AIDS_ 17:

1803–1809 Article  Google Scholar  * Gebo KA et al. (2003) Hospitalization rates differ by hepatitis C satus in an urban HIV cohort. _J Acquir Immune Defic Syndr_ 34: 165–173 Article  Google

Scholar  * Bica I et al. (2001) Increasing mortality due to end-stage liver disease in patients with human immunodeficiency virus infection. _Clin Infect Dis_ 32: 492–497 Article  CAS 

Google Scholar  * Strader DB et al. (2004) Diagnosis, management, and treatment of hepatitis C. _Hepatology_ 39: 1147–1171 Article  Google Scholar  * Benson CA et al. (2004) Treating

Opportunistic Infections Among HIV-Infected Adults and Adolescents. Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/Infectious Diseases Society

of America. MMWR Recommendations and Reports. 53(RR15): 1–112 * Soriano V et al. (2002) Care of patients with chronic hepatitis C and HIV co-infection: recommendations from the HIV–HCV

International Panel. _AIDS_ 16: 813–828 Article  Google Scholar  * Soriano V et al. (2004) Consensus conference on chronic viral hepatitis and HIV infection: updated Spanish recommendations.

_J Viral Hepat_ 11: 2–17 Article  CAS  Google Scholar  * Alter MJ et al. (1999) The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. _N Engl J Med_ 341:

556–562 Article  CAS  Google Scholar  * Browne R et al. (2004) Increased numbers of acute hepatitis C infections in HIV positive homosexual men; is sexual transmission feeding the increase?

_Sex Transm Infect_ 80: 326–327 Article  CAS  Google Scholar  * Tedaldi EM et al. (2003) Influence of coinfection with hepatitis C virus on morbidity and mortality due to human

immunodeficiency virus infection in the era of highly active antiretroviral therapy. _Clin Infect Dis_ 36: 363–367 Article  Google Scholar  * Benhamou Y et al. (1999) Liver fibrosis

progression in human immunodeficiency virus and hepatitis C virus coinfected patients. The Multivirc Group. _Hepatology_ 30: 1054–1058 Article  CAS  Google Scholar  * Darby SC et al. (1997)

Mortality from liver cancer and liver disease in haemophilic men and boys in UK given blood products contaminated with hepatitis C. _Lancet_ 350: 1425–1431 Article  CAS  Google Scholar  *

Graham CS et al. (2001) Influence of human immunodeficiency virus infection on the course of hepatitis c virus infection: a meta-analysis. _Clin Infect Dis_ 33: 562–569 Article  CAS  Google

Scholar  * Goedert JJ et al. (2002) End-stage liver disease in persons with hemophilia and transfusion- associated infections. _Blood_ 100: 1584–1589 CAS  PubMed  Google Scholar  * Puoti M

et al. (2004) Hepatocellular carcinoma in HIV-infected patients: epidemiological features, clinical presentation and outcome. _AIDS_ 18: 2285–2293 Article  Google Scholar  * Fanning L et al.

(1999) Viral load and clinicopathological features of chronic hepatitis C (1b) in a homogeneous patient population. _Hepatology_ 29: 904–907 Article  CAS  Google Scholar  * Martin-Carbonero

L et al. (2004) Incidence and predictors of severe liver fibrosis in human immunodeficiency virus-infected patients with chronic hepatitis C: a European collaborative study. _Clin Infect

Dis_ 38: 128–133 Article  Google Scholar  * Mehta SH et al. (2005) Effect of antiretroviral therapy on liver disease among adults with HIV and hepatitis C coinfection. _Hepatology_ 41:

123–131 Article  Google Scholar  * Soriano V et al. (2003) Treatment of chronic hepatitis C virus infection: we must target the virus or liver fibrosis? _AIDS_ 17: 751–753 Article  Google

Scholar  * Lucas GM et al. (2002) Longitudinal assessment of the effects of drug and alcohol abuse on HIV-1 treatment outcomes in an urban clinic. _AIDS_ 16: 767–774 Article  Google Scholar

  * Mauss S et al. (2004) A prospective controlled study of interferon-based therapy of chronic hepatitis C in patients on methadone maintenance. _Hepatology_ 40: 120–124 Article  CAS 

Google Scholar  * Chung RT et al. (2004) Peginterferon Alfa-2a plus ribavirin versus interferon alfa-2a plus ribavirin for chronic hepatitis C in HIV-coinfected persons. _N Engl J Med_ 351:

451–459 Article  CAS  Google Scholar  * Torriani FJ et al. (2004) Peginterferon Alfa-2a plus ribavirin for chronic hepatitis C virus infection in HIV-infected patients. _N Engl J Med_ 351:

438–450 Article  CAS  Google Scholar  * Laguno M et al. (2004) Peginterferon alfa-2b plus ribavirin compared with interferon alfa-2b plus ribavirin for treatment of HIV/HCV co-infected

patients. _AIDS_ 18: F27–F36 Article  CAS  Google Scholar  * Carrat F et al. (2004) Pegylated interferon alfa-2b vs standard interferon alfa-2b, plus ribavirin, for chronic hepatitis C in

HIV-infected patients: a randomized controlled trial. _JAMA_ 292: 2839–2848 Article  CAS  Google Scholar  * Mauss S et al. (2004) Risk factors for hepatic decompensation in patients with

HIV/HCV coinfection and liver cirrhosis during interferon-based therapy. _AIDS_ 18: F21–F25 Article  CAS  Google Scholar  * Hadziyannis SJ et al. (2004) Peginterferon-alpha2a and ribavirin

combination therapy in chronic hepatitis C: a randomized study of treatment duration and ribavirin dose. _Ann Intern Med_ 140: 346–355 Article  CAS  Google Scholar  * Vogt MW et al. (1987)

Ribavirin antagonizes the effect of azidothymidine on HIV replication. _Science_ 235: 1376–1379 Article  CAS  Google Scholar  * Hoggard PG et al. (1997) Effects of drugs on

2',3'-dideoxy-2',3'-didehydrothymidine phosphorylation in vitro. _Antimicrob Agents Chemother_ 41: 1231–1236 Article  CAS  Google Scholar  * Baba M et al. (1987)

Ribavirin antagonizes inhibitory effects of pyrimidine 2',3'- dideoxynucleosides but enhances inhibitory effects of purine 2',3'- dideoxynucleosides on replication of

human immunodeficiency virus in vitro. _Antimicrob Agents Chemother_ 31: 1613–1617 Article  CAS  Google Scholar  * Gries J-M et al. (online 8 February 2004) Effect of Ribavirin on

Intracellular and Plasma Pharmacokinetics of Nucleoside Reverse Transcriptase Inhibitors in Patients With HCV/HIV Co-infection: Final Results of a Randomized Clinical Study. (Abstract

136LB). 11th Conference on Retroviruses and Opportunistic Infections, San Francisco, CA [http://www.aegis.com/conferences/11croi/136LB.html] (accessed 6 April 2005) * Brau N et al. (2004)

Treatment of chronic hepatitis C in HIV/HCV-coinfection with interferon alpha-2b+ full-course vs. 16-week delayed ribavirin. _Hepatology_ 39: 989–998 Article  CAS  Google Scholar  *

Dieterich DT et al. and the HIV/HCV Co-infection Study Group (online 8 February 2004) Epoetin-Alfa administered Once Weekly Improves Anemia in HIV/HCV Co-infected Patients Treated with

Interferon/Ribavirin Therapy: A Prospective, Randomized Study. (Abstract 824). 11th Conference on Retroviruses and Opportunistic Infections, San Francisco, CA

[http://www.retroconference.org/2004/cd/Abstract/824.htm] (accessed 6 April 2005) * Panel on Clinical Practices for Treatment of HIV Infection convened by the Department of Health and Human

Services (DHHS) (online October 29, 2004) Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. [http://aidsinfo.nih.gov/guidelines/default_db2.asp?id=50]

(accessed 6 April 2005) Download references ACKNOWLEDGEMENTS The author receives support, in the form of grants, from the NIH (ROI DA016065; ROI DA13906). AUTHOR INFORMATION AUTHORS AND

AFFILIATIONS * Associate Professor of Medicine and Medical Director of the Viral Hepatitis Center at Johns Hopkins Medical Institutions, Baltimore, MD, USA Mark S Sulkowski Authors * Mark S

Sulkowski View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING AUTHOR Correspondence to Mark S Sulkowski. ETHICS DECLARATIONS COMPETING

INTERESTS M Sulkowski is an Advisory Board member for, or has received grants or funding/lecture sponsorship/honoraria from continuing medical education programs from, Roche and Schering

Plough. GLOSSARY * RIBAVIRIN (RBV) An antiviral guanosine nucleoside analog used in conjunction with interferon/pegylated interferon to treat hepatitis C * FILGRASTIM Recombinant methionyl

human granulocyte colony-stimulating factor * EPOETIN ALFA A man-made form of erythropoietin that stimulates the production of red blood cells * CHILD–PUGH CLASS A scoring system used to

evaluate prognosis of cirrhosis. Serum levels of bilirubin and albumin, prothrombin time, ascites, and encephalopathy are measured, and patients are divided into classes A (score 5–6), B

(7–9) and C (10–15) * DIDANOSINE A nucleoside reverse transcriptase inhibitor used to treat HIV infection RIGHTS AND PERMISSIONS Reprints and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE

Sulkowski, M. Therapy Insight: management of hepatitis C in patients coinfected with HIV. _Nat Rev Gastroenterol Hepatol_ 2, 223–231 (2005). https://doi.org/10.1038/ncpgasthep0170 Download

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