Treatment of HCV in the setting of HIV coinfection

Simultaneous infection with HIV and HCV is associated with an increased rate of progression to liver cirrhosis, increased risk of HCC and increased mortality,[87] even in those achieving full HIV virological suppression with antiretroviral treatment (ART) for HIV.[88,89] Eradication of HCV can prevent these complications, and people with HCV–HIV coinfection should be prioritised for treatment of HCV. In contrast to IFN-containing regimens, IFN-free DAA regimens for HCV are just as effective in the setting of HCV–HIV coinfection as they are in HCV mono-infection.[90-95] Drug–drug interactions, cumulative drug toxicities and increased pill burden are the main considerations when planning HCV treatment in people living with HIV. It is also important to note that thrombocytopaenia may occur secondary to HIV infection rather than portal hypertension; this may influence interpretation of APRI and FIB-4 serum markers for liver fibrosis staging. Serum bilirubin levels may be elevated by ARTs that inhibit biliary transporters. People with HIV–HCV coinfection should be cared for by a multidisciplinary team with experience in managing both viral infections.