Considerations for Antiretroviral Use in Patients with Coinfections
Hepatitis C Virus/HIV Coinfection
Last Updated: October 25, 2018; Last Reviewed: October 25, 2018
Panel's Recommendations Regarding Hepatitis C Virus/HIV Coinfection
- All people with HIV should be screened for hepatitis C virus (HCV) infection (AIII). Patients at high risk of HCV infection should be screened annually and whenever incident HCV infection is suspected (AIII).
- Antiretroviral therapy (ART) may slow the progression of liver disease by preserving or restoring immune function and reducing HIV-related immune activation and inflammation. For most persons with HCV/HIV coinfection, including those with cirrhosis, the benefits of ART outweigh concerns regarding drug-induced liver injury. Therefore, ART should be initiated in all patients with HCV/HIV coinfection, regardless of CD4 T lymphocyte cell count (AI).
- Initial ART regimens that are recommended for most patients with HCV/HIV coinfection are the same as those recommended for individuals without HCV infection. However, when treatment for both HIV and HCV is indicated, the ART and HCV treatment regimens should be selected with special consideration for potential drug-drug interactions and overlapping toxicities (AIII) (see discussion in the text below and in Table 13).
- All patients with HCV/HIV coinfection should be evaluated for HCV therapy, which includes having their liver fibrosis stage assessed to inform the length of their therapy and subsequent risk of hepatocellular carcinoma and liver disease complications (AIII).
- Persons with chronic HCV/HIV coinfection should be screened for active and prior hepatitis B virus (HBV) infection by testing for the presence of hepatitis B surface antigen (HBsAg) and antibodies to hepatitis B surface (HBsAb) and core (HBcAb; total or IgG). Persons who are not immune to HBV infection (HBsAb negative) should receive anti-HBV vaccination (AIII).
- HBV reactivation has been observed in persons with HBV infection during HCV treatment with direct-acting antivirals (DAAs). Accordingly, persons with HCV/HIV coinfection and active HBV infection (HBsAg positive) should receive ART that includes two agents with anti-HBV activity prior to initiating HCV therapy (AIII).