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March 24/31, 2015

Hepatitis C and HIV Co-infection: Closing the Gaps

Author Affiliations
  • 1Viral Hepatitis Center, Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts
JAMA. 2015;313(12):1217-1218. doi:10.1001/jama.2015.1111

Hepatitis C virus (HCV) infection causes substantial morbidity and mortality, but patients with human immunodeficiency virus (HIV) co-infection are 3 times more likely to develop cirrhosis or liver decompensation than those infected with hepatitis C alone.1 Unlike the treatment of HIV, for which the goal is viral suppression, treatment of hepatitis C is finite in duration, and the goal is to achieve a sustained virologic response (SVR), which is a lack of detectable HCV RNA at least 12 weeks after completion of treatment. Clinically, SVR is considered to represent eradication of hepatitis C infection, although reinfection is possible. Achieving SVR is associated with a significant decrease in subsequent decompensation of liver function, liver cancer, and all-cause mortality in persons with HIV co-infection.2 However, treatment of hepatitis C in patients with HIV co-infection has been limited by the reluctance of many HIV clinicians to use interferon alfa and the hesitation of many hepatologists to treat persons with HIV.