Management of chronic hepatitis C in HIV-infected patients.

Coinfection with hepatitis C virus (HCV) is common among persons infected with the human immunodeficiency virus (HIV). Treatment regimens based on standard interferon α (IFN α) and ribavirin (RBV) are recommended for chronic HCV, but they pose special concerns in patients coinfected with HIV, particularly those patients who are receiving antiretroviral therapy. Recently, several randomized studies comparing the safety and efficacy of pegylated interferon α (PEG-IFN α) plus RBV to IFN α plus RBV for the treatment of HCV in HIV-coinfected patients have been completed. In the AIDS Clinical Trials Group A5071 and RIBAVIC (sponsored by the French National Research Group) trials, superior sustained virologic responses were obtained with PEG-IFN α plus RBV compared to IFN α plus RBV. Findings from these studies suggest that PEG-IFN α plus RBV regimens may provide clinical benefit even in the absence of virologic clearance. An overview of these studies is presented. (Adv Stud Med. 2005;5(4C):S366-S370) O ver the past decade, the introduction of highly active antiretroviral therapy (HAART) for the treatment of human immunodeficiency virus (HIV) has shifted the spectrum of disease morbidity and mortality in these patients. Liver disease associated with chronic hepatitis C virus (HCV) and drug-induced hepatotoxicity has emerged as one of the most complex and important determinants of health in patients with HIV infection and AIDS. Experience in treating HCV infection in patients with HIV has been largely dictated by experience in treating patients infected with only HCV. The current standard of care for chronic infection with HCV in patients with no other infections is pegylated interferon α (PEG-IFN α)-2a or -2b plus ribavirin (RBV). This combination of PEG-IFN α plus RBV produces sustained virologic response (SVR) rates of 54% to 63% in patients with HCV alone. Given the importance of treating HCV infection in patients coinfected with HIV, the efficacy of this combination in the setting of HIV coinfection has recently been evaluated in several randomized clinical trials. Findings from these trials indicate that PEGIFN α plus RBV is well tolerated and provides superior rates of SVR when compared to interferon (IFN) α plus RBV regimens in patients infected with HIV and HCV. Furthermore, PEG-IFN α plus RBV may provide clinical benefits even in the absence of virologic clearance. This article reviews the rationale and special considerations for the use of PEG-IFN α plus RBV therapy. Results from 2 recently completed large randomized trials are highlighted in this overview: the AIDS Clinical Trials Group (ACTG) A5071 (PEGIFN α-2a plus RBV) and the French RIBAVIC (PEGIFN α-2b plus RBV), both comparing PEG-IFN α plus RBV to IFN α plus RBV. REVIEW