HIV/HCV Coinfection

The prevalence of HCV coinfection is higher than most people realize. In the United States, HCV prevalence among all PLWHA is estimated to be 15 to 30 percent, and it is more than three times higher—from 50 to 90 percent—among people who acquired HIV through IDU.2-4 People who are coinfected with HCV and HIV are more likely than those with HCV alone to develop end-stage liver disease because HIV accelerates progression of HCV. Hepatitis C can be treated, even in PLWHA. End-stage liver disease is preventable in many patients: The first steps are educating patients about HCV, providing appropriate screening and diagnosis, and assessing the need for HCV treatment, all in a supportive context.

HCV is an opportunistic infection of HIV disease. In the era of highly active antiretroviral therapy (HAART), HCV coinfection has become a prominent contributor to morbidity and mortality among PLWHA.

Many experts regard HCV infection as a “different animal” in PLWHA, because liver disease progresses more rapidly in people who are HIV positive. HCV-associated liver damage appears to be more likely to develop in HIV/HCV-coinfected people than in those with HCV monoinfection. Coinfected people with <200 CD4 cells/mL are at greatest risk for end-stage liver disease.36-38

One study evaluated paired liver biopsies from 61 coinfected patients and found that liver disease progressed by two stages or more in 28 percent (17 of 61 participants) over an interval of less than 3 years.39 A similar study in people with HCV monoinfection reported that only 11 percent (23 of 210 participants) progressed by two stages or more in a similar time period (median of 2.5 years).40

A meta-analysis of eight studies reported that coinfected patients were twice as likely to develop cirrhosis than patients with HCV alone. They had a sixfold greater risk for hepatic decompensation (decreased liver function due to damage for which the liver cannot compensate).41