HIV/HCV coinfection in clinical practice

ArticleinJournal of the International Association of Physicians in AIDS Care (JIAPAC) 3 Suppl 1:S4-14; quiz S16-7 · November 2004with2 Reads
Source: PubMed
Abstract

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) frequently co-exist due to shared routes of transmission. In the past, the impact of HCV on overall morbidity and mortality of coinfected patients was minimal due to the poor prognosis of HIV. However, since the introduction of highly active antiretroviral therapy (HAART), HCV has become a significant pathogen in this population. HIV clearly exacerbates HCV infection and accelerates progression to cirrhosis, end-stage liver disease, and hepatocellular carcinoma. There is debate over whether HCV influences the natural history of HIV. Given the high prevalence of coinfection and the accelerated liver damage, HCV treatment has become a priority in these patients. There are new data on pegylated interferon (PEG-IFN) and ribavirin (RBV) therapy for HCV in coinfected patients. The therapy is well tolerated and safe, although it appears to be slightly less effective than in monoinfected patients. The risk of HAART-related hepatotoxicity is greater in coinfected patients and therefore requires special consideration and close monitoring.

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  • [Show abstract] [Hide abstract] ABSTRACT: Morbidity and mortality associated with HIV infection have rapidly decreased with the introduction of highly active antiretroviral therapy. Of recent concern is the increase of unusual opportunistic infections, particularly hepatitis C virus in this population. Because of the shared route of transmission, a significant number of HIV-infected patients are also coinfected with hepatitis C virus. HIV infection has been demonstrated to increase the rate of hepatitis C virus disease progression. New data on the use of pegylated interferon plus ribavirin indicate that while cure of hepatitis C virus in the coinfected patient is a clinical challenge, it is possible. Aggressive management of anemia, drug-induced depression, and drug interactions increase the opportunity for clinical response and positive patient outcomes.
    Preview · Article · Feb 2006 · Journal of Pharmacy Practice
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  • [Show abstract] [Hide abstract] ABSTRACT: This was a 36-day, open-label, fixed-sequence, multiple-dose drug interaction study in 23 healthy subjects to evaluate the effects of multiple doses of tenofovir disoproxil fumarate on the single-dose pharmacokinetics of ribavirin. Subjects received a 600-mg once-daily oral dose of ribavirin on days 1 and 22 and 300-mg once-daily oral doses of tenofovir disoproxil fumarate on days 17 through 24. Pharmacokinetic sampling was performed on days 1 through 4 and 22 through 25. Pharmacokinetics of ribavirin was not altered by its coadministration with tenofovir disoproxil fumarate as the point estimates (day 22 [test treatment]/day 1 [reference treatment]), and the 90% confidence interval for maximum observed concentration (0.95; 88.7-101) and area under the plasma concentration-time curve up to time of last measurable concentration (1.12; 106-117) were within the equivalence bounds of 80% to 125%. Tenofovir pharmacokinetics after ribavirin coadministration was similar to that observed in previous studies. These results indicate that coadministration of tenofovir disoproxil fumarate and ribavirin does not result in substantial changes to their individual pharmacokinetic profiles.
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