Ask the Experts - How Do You Treat the Patient With HCV and HIV...
What clinical parameters should be followed to allow interferon treatment of the hepatitis C patient with significant liver disease who is also coinfected with HIV?

Geoffrey L. Braden, MD



Patients with HIV and hepatitis C virus (HCV) coinfection should be followed in the same way while on therapy -- ie, with measurement of serum aminotransferases and blood count 2 and 4 weeks after starting treatment and then every 4 weeks, for the duration of therapy. Serum HCV RNA should be tested after 6 months of therapy to determine the adequacy of a response. If HCV is still detectable at that time, therapy should probably be stopped. If HCV RNA is no longer detectable, therapy can be stopped in those infected with HCV genotypes 2 and 3 while it should be continued for a full 12 months in those with the more common genotype 1.

Few large controlled trials of combination therapy with interferon and ribavirin have been done on patients with HIV coinfection. Available data suggest that those patients with adequate CD4 counts (> 400/mL) have rates of response similar to those who are not HIV-infected. Most clinicians recommend that control of the HIV infection should be the first priority and that therapy for HCV should only be considered when the HIV is stable and under control.