May 13, 2013

Facing the Challenges in Managing HCV/HIV Coinfection

Mark R. Nelson, MD

DisclosuresMay 13, 2013

Editor's Note: The International Conference on Viral Hepatitis (ICVH) 2013 -- held in New York on March 25-26, 2013, and jointly sponsored by the International Association of Providers of AIDS Care and the Icahn School of Medicine at Mount Sinai -- was designed to update practitioners and scientists on the most recent advances in the management of hepatitis B virus, hepatitis C virus (HCV), and HIV/hepatitis coinfection.

Mark R. Nelson, MD, Physician and Clinical Lead for In-Patient Services at the Chelsea and Westminster Hospital in London, United Kingdom, and Co-chair of ICVH 2013, shared his thoughts on some of the key issues discussed at the conference.

We are continually learning about the management of patients with HCV infection and are exploring new ways to improve treatment outcomes in both monoinfected and HCV/HIV-coinfected patients.

With the wide array of new drugs and new treatment approaches on the horizon,[1] we need to take a step back and consider the personal and public health implications of immediate treatment, given the unknown drug/drug interactions and toxicities -- especially in coinfected patients.[2-4]

But we know that we cannot hold off on treatment for too long. Among coinfected patients in particular, survival in those with end-stage liver disease is poor, and the value of transplantation in this population is still being debated.[5]

Another critical issue that needs to be addressed is the growing epidemic of acute hepatitis C among patients with HIV -- first described at our hospital -- that is rapidly replacing those with chronic HCV infection who were successfully treated.[6] The reinfection rate in these patients can be high, and treatment can be costly. How will that affect patients who need repeated treatments over the long term?

This is a very exciting time for clinicians and researchers involved in the management of patients with HCV infection. But it is also a time in which we need to consider how to obtain the data we need to develop strategies that can offer the best opportunity for improved outcomes.

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