Antiretroviral Therapy Reduces the Rate of Hepatic Decompensation Among HIV- and Hepatitis C Virus–Coinfected Veterans:
Jeffrey P. Anderson, Eric J. Tchetgen, Vincent Lo Re III, Janet P. Tate, Paige L. Williams, George R. Seage III, C. Robert Horsburgh, Joseph K. Lim, Matthew Bidwell Goetz, David Rimland, Maria C. Rodriguez-Barradas, Adeel A. Butt, Marina B. Klein, and Amy C. Justice: HIV/AIDS Clinical Infectious Diseases 2013

Initiation of ART significantly reduced the rate of hepatic decompensation by 28%–41% on average. These results suggest that ART should be administered to HIV/HCV-coinfected patients to lower the risk of end-stage liver disease.

Breaking Down the Barriers to Hepatitis C Virus (HCV) Treatment Among Individuals With HCV/HIV Coinfection: Action Required at the System, Provider, and Patient Levels
Jason Grebely, Megan Oser, Lynn E. Taylor, and Gregory J. Dore; The Journal of Infectious Diseases 2013;207(S1):S19–25

This review will outline barriers to HCV care in HCV/HIV coinfection, with a particular emphasis on persons who inject drugs, proposing strategies to enhance HCV treatment uptake and outcomes.

Fibrosis Progression in Human Immunodeficiency Virus/Hepatitis C Virus Coinfected Adults:
Prospective Analysis of 435 Liver Biopsy Pairs: Konerman et al. Hepatology 2013

Human immunodeficiency virus (HIV)/hepatitis C virus (HCV) coinfection is associated with progressive liver disease. However, the rate of progression is variable and the ability to differentiate patients with stable versus progressive HCV disease is limited.  The objective of this study was to assess the incidence of and risk factors for fibrosis progression in a prospective cohort of coinfected patients.

Hepatic Decompensation in Antiretroviral-Treated Patients Co-Infected With HIV and Hepatitis C Virus Compared With Hepatitis C Virus Monoinfected Patients A Cohort Study:
Vincent Lo Re III, MD, MSCE; Michael J. Kallan, MS; Janet P. Tate, ScD; A. Russell Localio, PhD; Joseph K. Lim, MD; Matthew Bidwell Goetz, MD; Marina B. Klein, MD, MS; David Rimland, MD; Maria C. Rodriguez-Barradas, MD; Adeel A. Butt, MD, MS; Cynthia L. Gibert, MD, MS; Sheldon T. Brown, MD; Lesley Park, MPH; Robert Dubrow, MD, PhD; K. Rajender Reddy, MD; Jay R. Kostman, MD; Brian L. Strom, MD, MPH; & Amy C. Justice,MD, PhD; Annals of Internal Medicine March 2014

Despite receiving ART, patients co-infected with HIV and HCV had higher rates of hepatic decompensation than HCV monoinfected patients. Rates of decompensation were higher for co-infected patients with advanced liver fibrosis, severe anemia, diabetes, and nonblack race.

Cost Per SVR in Coinfected Individuals.

Slide presentation of costs associated with HCV treatment with coinfected individuals.

Drug Interactions with Hepatitis C Virus Direct Acting Antivirals and HIV Medications:
A Quick Guide for Clinicians – Updated February 20, 2014 John J Faragon, PharmD, BCPS, AAHIVP, Douglas Fish, MD, Marshall Glesby, MD, PhD; NY/NJ AIDS Education Training Centre 2014

Chart offers easy to read reference for those who are interested in interactions of HCV DAAs and HIV medications.

Does HIV Remain a Risk Factor for Achieving Sustained Virological Response (SVR) under DAA-Based Modern HCV Therapy?
Jürgen Kurt Rockstroh, Clinical Infectious Diseases 2014

First pilot trials with direct acting antivirals (DAAs) in particular the first generation HCV protease inhibitors telaprevir and boceprevir however, showed similarly increased cure rates in HIV-coinfected HCV treatment naive patients as in treatment of HCV monoinfection with cure rates between 63-74%. However, these were highly selected small patient groups without advanced fibrosis or previous non-response to IFN-based therapy. Therefore, the question in the coinfection field clearly was how will these new treatment advances translate into more difficult-to-treat real world patient populations.

HIV, HCV, and Drug Use in Men who have Sex with Men:
Tony Kirby & Michelle Thornber-Dunwell: The Lancet, Vol 382 September 2013

The report by Tony Kirby and Michelle Thornber-Dunwell uncovers an emerging and troubling public health and community issue. The intersection of unprotected sex and use of street and party drugs is likely to amplify the transmission of HIV, hepatitis C virus (HCV), and sexually transmitted infections (STI) in men who have sex with men (MSM).

Interferon Response Reduces Liver Disease and Death in HIV/HCV Coinfected:
J Berenguer, FX Zamora, C Díez, et al.: 53rd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2013). Denver, September 10-13, 2013. Abstract H-1527.

Effective interferon-based therapy that produces sustained virological response
(SVR) led to significant reductions in liver decompensation, HIV disease progression, and both overall and liver-related mortality among HIV/HCV coinfected patients, according to a presentation at the 53rd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2013)

Liver-related death among HIV/HCV coinfected individuals, implications for the era of directly acting antivirals:
D Grint, L Peters, A Rakmanova, J K Rockstroh, I Karpov, M Galli, P Domingo, O Kirk, J D Lundgren, A Mocroft: CROI 2014 March 3-6 Boston, MA

LRD accounted for 27% of all deaths in HIV/HCV coinfected patients in EuroSIDA, on par with AIDS as the leading cause of death. The rate of LRD peaked between the ages 35-45 and was highest in the West Central and North regions. LRD occurred almost exclusively among those with significant liver fibrosis (Metavir ≥F2) and HCV treatment with DAAs should be prioritised for this group

Management of HCV and HIV Infections among People Who Inject Drugs,
Jason Grebely and Mark W. Tyndall, Curr Opin HIV AIDS 6:501–507: 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 1746-630X

There are compelling data demonstrating that with the appropriate programs, treatment for HIV and HCV among IDUs is successful. However, assessment and treatment for HCV and HIV lags far behind the numbers of IDUs who could benefit from therapy, related to systems, provider and patient-related barriers to care. Novel strategies to enhance assessment, uptake and response to treatment should be evaluated among IDUs to elucidate mechanisms to enhance care for this underserved population.

Managing HIV/Hepatitis C Co-Infection in the Era of Direct Acting Antivirals;
Jürgen K Rockstroh and Sanjay Bhagani; BMC Medicine 2013, 11:234

Morbidity and mortality from co-morbid hepatitis C (HCV) infection in HIV co-infected patients are increasing; hence, the management of hepatitis co-infection in HIV is now one of the most important clinical challenges. Therefore, the development of direct acting antivirals (DAAs) for treatment of HCV has been eagerly awaited to hopefully improve HCV treatment outcome in co-infected individuals. Nevertheless, numerous challenges remain,including choice of patients to treat, potential for drug-drug interactions and overlapping toxicities between HIV and HCV therapy. The dramatically improved rates of HCV cure under new triple therapy, however, warrant evaluation of these new treatment options for all co-infected patients.

Management of Patients Coinfected With HCV and HIV: A Close Look at the Role for Direct-Acting Antivirals;
Susanna Naggie and  Mark S. Sulkowsk; Gastroenterology . 2012 May ; 142(6): 1324–1334.e3. doi:10.1053/j.gastro.2012.02.012.

With the development of effective therapies against human immunodeficiency virus (HIV), hepatitis C virus (HCV) infection has become a major cause of morbidity and mortality among patients with both infections (coinfection).  Recently developed HCV protease inhibitors such as telaprevir and boceprevir, given in combination with pegylated IFN and RBV, could increase the rate of SVR with manageable toxicity and drug interactions. We review the latest developments and obstacles to treating coinfected patients.

Temporal Changes and Regional Differences in Treatment Uptake of Hepatitis C Therapy in EuroSIDA;
D Grint, L Peters, C Schwarze-Zander, M Beniowski, C Pradier, M Battegay, D Jevtovic, V Soriano, JD Lundgren, JK Rockstroh, O Kirk and A Mocroft for EuroSIDA in EuroCoord; HIV Medicine (2013)

All HIV/hepatitis C virus (HCV)-coinfected patients with chronic HCV infection and _ F2 fibrosis should be considered for HCV therapy. This study aimed to determine the rate of HCV treatment uptake among coinfected patients in Europe.

Relationship Between Alcohol Use Categories and Noninvasive Markers of Advanced Hepatic Fibrosis in HIV-Infected, Chronic Hepatitis C Virus–Infected, and Uninfected Patients;
Joseph K. Lim, Janet P. Tate, Shawn L. Fultz, Joseph L. Goulet, Joseph Conigliaro, Kendall J. Bryant, Adam J. Gordon, Cynthia Gibert, David Rimland, Matthew Bidwell Goetz, Marina B. Klein, David A. Fiellin, Amy C. Justice, and Vincent Lo Re III; Clinical Infectious Diseases 2014;58(10):1449–58

There may be no “safe” level of alcohol consumption among HIV+ and HCV+. Advanced hepatic fibrosis was present at low levels of alcohol consumption, increased with alcohol use categories, and was greater in HIV-infected than uninfected individuals.

Treatment of Opioid Dependence and Coinfection with HIV and Hepatitis C Virus in Opioid-Dependent Patients: The Importance of Drug Interactions between Opioids and Antiretroviral Agents;
Elinore F. McCance-Katz; Clinical Infectious Diseases 2005; 41:S89–95

The present article summarizes current knowledge about interactions between
methadone and antiretroviral medications. Methadone has significant, adverse drug-drug interactions with many antiretroviral therapeutic agents that can contribute to nonadherence and poor clinical outcomes
in this high-risk population.

CROI 2014: Viral Hepatitis and Complications of HIV Disease and Antiretroviral Therapy
Anne F. Luetkemeyer, MD; Diane V. Havlir, MD; and Judith S. Currier, MD; Conference Highlights—CROI 2014: HIV Complications Volume 22  Issue 2  May 2014

The remarkable advances in interferon-sparing, all-oral HCV treatment were a highlight of the 2014 Conference onRetroviruses and Opportunistic Infections (CROI).  HIV coinfection does not appear to negatively impact response to DAA-based HCV therapy, as evidenced by similar response rates in HIV/HCV-coinfected
patients compared with HCV-monoinfected patients receiving interferonsparing or -containing regimens.  HIV/HCV-coinfected patients have demonstrated an excellent and generally equivalent response to DAA
regimens. Thus, coinfected patients should no longer be expected to have a suboptimal response on the basis of HIV coinfection, as was the case in the pre-DAA, interferon-based treatment era.