Examination of Fiscal Management and the Allocation of Care Act Resources US Department of Health and Human Services: Health REsources and Services Administration
INTRODUCTION
HIV/HCV Coinfection
HCV Treatment
Response to HCV Treatment: Prognostic Factors
Liver Biopsy
Treatment Strategies
Side Effects and Strategies for Managing Them
The Week 12 Early-Stopping Rule
Treating HCV: Long-Term Benefits
Treatment of Acute HCV
Expanding Access to Treatment
Barriers and Key Issues
Conclusion
Resources
References

Treatment Strategies

Researchers are exploring optimal strategies for treating HIV and HCV in coinfected patients. Initiating HAART prior to HCV treatment may improve response rates to HCV treatment.122 Several factors must be considered in making treatment decisions:

  • The patient must be willing and ready to treat both HIV and HCV.
  • If CD4 cell count is less than 200/mL, HIV treatment should be initiated first.
  • If HCV disease is mild, treatment can be delayed. If treatment is indicated according to current guidelines (Table 6) and there is patient readiness, HCV should be treated either before initiation of HAART or while the patient is on a stable antiretroviral drug regimen. Antiretroviral regimens for coinfected people should be selected carefully to reduce the risk of hepatoxicity and avoid interactions with HCV treatment. Avoid HAART regimens that contain didanosine (ddI; Videx), because of a potentially life-threatening interaction with ribavirin123 and potentiation of the risk for hepatic decompensation in coinfected cirrhotic patients during HCV treatment.118 If possible, zidovudine (AZT; Retrovir) should be avoided because it increases the risk of anemia from ribavirin124; stavudine (d4T; Zerit) may increase the risk for lipoatrophy and weight loss during HCV treatment.96

Table 6

Often, real-life situations are less clear-cut. Because many people present with both advanced HIV disease and advanced HCV disease, clinicians often start HAART first, so that side effects from antiretroviral agents can be identified and managed. Antiretroviral regimens for coinfected people should be selected carefully to reduce the risk for hepatotoxicity and avoid interactions with HCV treatment. Some patients who start HIV treatment with a low CD4 cell count do not achieve a CD4 count of more than 200/mL, although they have a stable or undetectable HIV RNA; those patients should be evaluated for HCV treatment on an individual basis. Although it is possible to initiate treatment for both viruses simultaneously, side effects and toxicities from medications make it difficult to do so.

 

 

 
 
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