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World J Virology. Feb 12, 2015; 4(1): 1-12
Published online Feb 12, 2015. doi: 10.5501/wjv.v4.i1.1
Treatment of chronic hepatitis C in patients with HIV/HCV coinfection
Nicola Coppola, Salvatore Martini, Mariantonietta Pisaturo, Caterina Sagnelli, Pietro Filippini, Evangelista Sagnelli
Nicola Coppola, Salvatore Martini, Mariantonietta Pisaturo, Pietro Filippini, Evangelista Sagnelli, Department of Mental Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, 80131 Naples, Italy
Mariantonietta Pisaturo, Division of Infectious Diseases, AORN Sant’Anna e San Sebastiano di Caserta, 81100 Caserta, Italy
Caterina Sagnelli, Department of Clinical and Experimental Medicine and Surgery “F. Magrassi e A. Lanzara”, Second University of Naples, 80131 Naples, Italy
Author contributions: Coppola N, Martini S, Pisaturo M, Sagnelli C, Filippini P and Sagnelli E authorship credit is based on (1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published.
Conflict-of-interest: All the authors of the manuscript declare that they have no conflict of interest in connection with this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Nicola Coppola, Department of Public Health and Public Medicine, Section of Infectious Diseases, Second University of Naples, Via: L. Armanni 5, 80131 Naples, Italy. nicola.coppola@unina2.it
Telephone: +39-081-5666719 Fax: +39-081-5666013
Received: November 15, 2014
Peer-review started: November 16, 2014
First decision: December 12, 2014
Revised: December 21, 2014
Accepted: January 9, 2015
Article in press: Janurary 12, 2015
Published online: February 12, 2015
Processing time: 169 Days and 4 Hours
Abstract

Hepatitis C virus (HCV) infection is one of the most frequent causes of comorbidity and mortality in the human immunodeficiency virus (HIV) population, and liver-related mortality is now the second highest cause of death in HIV-positive patients, so HCV infection should be countered with adequate antiviral therapy. In 2011 began the era of directly acting antivirals (DAAs) and the HCV NS3/4A protease inhibitors telaprevir and boceprevir were approved to treat HCV-genotype-1 infection, each one in combination with pegylated interferon alfa (Peg-IFN) + ribavirin (RBV). The addition of the first generation DAAs, strongly improved the efficacy of antiviral therapy in patients with HCV-genotype 1, both for the HCV-monoinfected and HIV/HCV coinfected, and the poor response to Peg-IFN + RBV in HCV/HIV coinfection was enhanced. These treatments showed higher rates of sustained virological response than Peg-IFN + RBV but reduced tolerability and adherence due to the high pill burden and the several pharmacokinetic interactions between HCV NS3/4A protease inhibitors and antiretroviral drugs. Then in 2013 a new wave of DAAs arrived, characterized by high efficacy, good tolerability, a low pill burden and shortened treatment duration. The second and third generation DAAs also comprised IFN-free regimens, which in small recent trials on HIV-positive patients have shown comforting preliminary results in terms of efficacy, tolerability and adherence.

Keywords: Hepatitis C virus infection; Human immunode-ficiency virus infection; Anti-hepatitis C virus treatment; Directly acting antivirals; HIV/HCV coinfection; Chronic hepatitis C

Core tip: The combination pegylated interferon alfa + ribavirin has been used infrequently in patients with Human immunodeficiency virus/hepatitis C virus (HIV/HCV) coinfection because of its limited efficacy in these patients, the high prevalence of medical and psychiatric comorbidities and the high incidence of serious adverse reactions. The introduction of directly acting antivirals has radically changed the scenario of the HIV/HCV coinfection treatment shown comforting preliminary results in terms of efficacy, tolerability and adherence. This paper provides a quick and comprehensive implementation guide to the managment of HIV/HCV patients in a historical moment in which it is not yet clear what is the best treatment.