Liver, Pancreas, and Biliary Tract: Clinical ReviewsHepatitis C in HIV-positive Patients—Treatment and Liver Disease OutcomesAdeyemi, Oluwatoyin M. MD Author Information Division of Infectious Diseases, CORE Center, Stroger Hospital of Cook County and Rush University Medical Center, Chicago, IL Reprints: Oluwatoyin M. Adeyemi, MD, 637 S. Wood Street, Durand Building, Chicago, IL 60612 (e-mail: [email protected]). Received for publication March 24, 2006; accepted June 21, 2006 Journal of Clinical Gastroenterology 41(1):p 75-87, January 2007. | DOI: 10.1097/01.mcg.0000225592.16448.f3 Buy Metrics Abstract Many human immunodeficiency virus (HIV) infected persons are coinfected with hepatitis C virus (HCV) and with the use of highly active antiretroviral therapy, liver disease from HCV has become an important cause of morbidity and mortality. The current guidelines recommend that human immunodeficiency virus and HCV coinfected patients be evaluated and treated for HCV if there are no major contraindications to treatment. Coinfected patients treated with pegylated interferon-a and ribavirin have sustained virologic responses (SVRs) of 27% to 40% which for a variety of reasons are lower than those reported in HCV mono-infected patients. Understanding that most patients will not achieve SVRs, strategies to evaluate for the role of maintenance interferon in delaying complications of liver disease are being evaluated. In patients who have failed prior treatment, cannot tolerate treatment, or who have contraindications to HCV treatment, the use of highly active antiretroviral therapy with careful monitoring for hepatotoxicity and aggressive counseling on alcohol and substance abuse may slow down fibrosis progression. As the data on liver transplantation in coinfected patients accumulate, patients with end stage liver disease should be referred early for evaluation in a transplant center. As new drugs for HCV are being developed, it will be of utmost importance to include coinfected patients earlier in the process on new drug trials and therapeutic strategies. © 2007 Lippincott Williams & Wilkins, Inc.