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December 15, 2004

Treatment of Hepatitis C in HIV-Infected Patients: Significant Progress But Not the Final Step

Author Affiliations

Author Affiliations: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.

JAMA. 2004;292(23):2909-2913. doi:10.1001/jama.292.23.2909

In the modern era of highly active antiretroviral therapy (HAART), hepatitis C virus (HCV) has emerged as a major cause of morbidity and death in human immunodeficiency virus (HIV) infection. An estimated 15% to 30% of HIV-infected individuals are coinfected with HCV, representing 150 000 to 300 000 patients in the United States alone.1 The prevalence of anti-HCV antibodies in HIV-infected persons differs significantly according to the HIV-exposure risk category, ranging from less than 10% in homosexual men to more than 85% in injecting drug users.1 In the vast majority of immunocompetent non–HIV-infected persons, chronic hepatitis C usually takes a relatively mild course, leading to liver cirrhosis in 2% to 25% after 20 to 25 years depending on the individual risk factor profile.2,3 Liver-related death is only slightly more frequent in HCV-infected individuals.4 In contrast, hepatitis C may take a much more severe course in HIV-infected patients.5 In men with hemophilia, the prevalence of cirrhosis as well as liver-related deaths is significantly higher in HCV-HIV–coinfected individuals than in patients infected with HIV alone.6 However, these findings may not necessarily reflect the situation in other cohorts in which HCV infection has not been shown to increase the risk of death.7