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    ABSTRACT: •Since highly active antiretroviral therapies became available, the future of HIV-infected patients has been transformed. However, 20 to 25% of HIV patients are co-infected with hepatitis B or C viruses, and the course of these diseases has worsened, since these patients have an enhanced sensitivity to the hepatic toxicity of antiretrovirals.•The relation between high antiretroviral concentrations and toxicity has been clearly demonstrated with certain protease inhibitors and non-nucleoside reverse transcriptase inhibitors (NNRTI) that have a predominantly hepatic metabolism (CYP4503A4). The nucleoside reverse transcriptase inhibitors (NRTI) are not predominantly metabolized by the liver, but may nevertheless be toxic for the liver through mitochondrial involvement.•The hepatic toxicity observed in a patient treated with early or delayed antiretrovirals may be due to a cytolytic, cholestatic or mixed, direct or indirect, mechanism.•Before initiating antiretroviral treatments, hepatic fibrosis must be explored (punch biopsy, biological fibrosis test, and Child-Pugh's score). It is recommended that the most hepatotoxic drugs be avoided, notably didanosine, didanosine+stavudine, nevirapine, and full-dose ritonavir.•Although it is possible to initiate an antiretroviral at the standard dose in patients with cirrhosis (the therapeutic margin with antiretrovirals is wide), early assays are essential, particularly with PI and NNRTI, to adjust the dose and avoid adverse events. In any event rigorous monitoring is a must.
    La Presse Médicale 06/2005; 34(10):1S45–1S52. DOI:10.1016/S0755-4982(05)73409-6 · 1.17 Impact Factor
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    ABSTRACT: Background.-Since the discovery of hepatitis C (HCV),. the efficacy of treatment has significantly progressed using standardmono-therapy: with Interferon alpha (IFN) during six months we obtained approximately 10% sustained response and currently with the association of pegylated IFN and Ribavirin a 55% sustained response was achieved.Current position and major points.-HCV infection continues to present therapeutic problems which have not entirely been solved, mainly related to clinical and biological tolerance, and non-responders. Moreover, the care of patients with extra-hepatic localization, cirrhotic patients, as well as therapeutic problems of co-infected HIV HCV patients. As regards hepatitis B (HBV) new effective treatments against this virus have appeared, IFN then nucleoside analogs, some of which are available in France (ie. lamivudine, adefovir, dipovoxil). The main objective of chronic hepatitis B treatment is to obtain the complete inhibition of the HBV virus by Hbe-antigen antibody seroconversion which would therefore significantly increase patient survival. In this article the advantages and disadvantages of the different treatments are assessed.Future perspectives.-Despite the considerable and rapid progress obtained in the therapeutic treatment of infection due to HCV andHBV a number of unknown factors remain, which warrants further trials, in particular to evaluate the efficacy as well as the tolerance of the antiviral agent association.
    La Revue de Médecine Interne 11/2002; 23:459S–474S. DOI:10.1016/S0248-8663(02)00660-4 · 1.32 Impact Factor
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    ABSTRACT: Coinfection with hepatitis C virus (HCV) and HIV is common. Studies conducted prior to the advent of highly active antiretroviral therapy reported increased HCV liver disease severity in coinfected persons compared with those infected with HCV alone. In the current era, the influences of HIV and highly active antiretroviral therapy on the natural history of HCV liver disease are less well defined. Peginterferon alfa and ribavirin are the current standard of care in treating HCV, but HIV coinfection is associated with lower response rates to treatment. Further research is needed to enhance our understanding of the natural history and pathogenesis of HCV liver disease in the setting of HIV coinfection and to identify more effective HCV treatments.
    Current Hepatitis Reports 05/2009; 6(2). DOI:10.1007/s11901-007-0003-x