Published online Sep 14, 2014. doi: 10.3748/wjg.v20.i34.12132
Revised: April 2, 2014
Accepted: June 26, 2014
Published online: September 14, 2014
Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) share the same transmission routes; therefore, coinfection is frequent. An estimated 5-10 million individuals alone in the western world are infected with both viruses. The majority of people acquire HCV by injection drug use and, to a lesser extent, through blood transfusion and blood products. Recently, there has been an increase in HCV infections among men who have sex with men. In the context of effective antiretroviral treatment, liver-related deaths are now more common than Acquired Immune Deficiency Syndrome-related deaths among HIV-HCV coinfected individuals. Morbidity and mortality rates from chronic HCV infection will increase because the infection incidence peaked in the mid-1980s and because liver disease progresses slowly and is clinically silent to cirrhosis and end-stage-liver disease over a 15-20 year time period for 15%-20% of chronically infected individuals. HCV treatment has rapidly changed with the development of new direct-acting antiviral agents; therefore, cure rates have greatly improved because the new treatment regimens target different parts of the HCV life cycle. In this review, we focus on the epidemiology, diagnosis and the natural course of HCV as well as current and future strategies for HCV therapy in the context of HIV-HCV coinfection in the western world.
Core tip: Hepatitis C virus (HCV) infection incidence has increased among men who have sex with men. Additionally, mortality and morbidity from chronic HCV infection has increased and liver-related deaths are now more common than Acquired Immune Deficiency Syndrome-related deaths. Several new direct-acting antiviral agents have been developed or are under development, and therapy strategies change faster than guidelines can be updated. This review focuses on the epidemiology, diagnosis, natural course and treatment of HCV infection in human immunodeficiency virus infected patients.