Hepatitis C virus eradication in people living with human immunodeficiency virus: Where are we now?

Abstract

Hepatitis C virus (HCV)/human immunodeficiency virus (HIV) co-infection still involves 2.3 million patients worldwide of the estimated 37.7 million living with HIV, according to World Health Organization. People living with HIV (PLWH) are six times greater affected by HCV, compared to HIV negative ones; the greater prevalence is encountered among people who inject drugs and men who have sex with men: the risk of HCV transmission through sexual contact in this setting can be increased by HIV infection. These patients experience a high rate of chronic hepatitis, which if left untreated progresses to end-stage liver disease and hepatocellular carcinoma (HCC) HIV infection increases the risk of mother to child vertical transmission of HCV. No vaccination against both infections is still available. There is an interplay between HIV and HCV infections. Treatment of HCV is nowadays based on direct acting antivirals (DAAs), HCV treatment plays a key role in limiting the progression of liver disease and reducing the risk of HCC development in mono- and coinfected individuals, especially when used at an early stage of fibrosis, reducing liver disease mortality and morbidity. Since the sustained virological response at week 12 rates were observed in PLWH after HCV eradication, the AASLD has revised its simplified HCV treatment algorithm to also include individuals living with HIV. HCV eradication can determine dyslipidemia, since HCV promotes changes in serum lipid profiles and may influence lipid metabolism. In addition to these apparent detrimental effects on the lipid profile, the efficacy of DAA in HCV/HIV patients needs to be considered in light of its effects on glucose metabolism mediated by improvements in liver function. The aim of the present editorial is to describe the advancement in HCV treatment among PLWH.

Keywords: Hepatitis; People living with human immunodeficiency virus; Direct acting antivirals; Highly active antiretroviral therapy; Co-infection

Core Tip: Considering the quite high prevalence of hepatitis C virus (HCV) co-infection in people living with human immunodeficiency virus (PLWH), along with the interplay of HCV and human immunodeficiency virus infections, the usefulness of direct acting antivirals (DAAs) therapy regimen for the cure of HCV in this context appears crucial. However, apart from several known drug-drug interactions between highly active antiretroviral therapy (HAART) and DAAs, the metabolic impact of HCV eradication in terms of worsening of lipid profile as well as the improvement of glucose metabolism must be taken into account. The treatment of HCV infection in PLWH under HAART represents a challenge as well as a great opportunity for clinicians and deserves attention.