Evaluation and Treatment of the HIV/HCV Coinfected Patient: A Case History and Discussion

Abstract

Declining rates of morbidity and mortality related to opportunistic infections in the era of highly active antiretroviral therapy (HAART) have led to a new focus on hepatitis C (HCV). Several studies suggest that the natural history of HCV is accelerated in patients with HIV infection. Recent literature highlights higher rates of fibrosis progression and increasing rates of morbidity and mortality related to end-stage liver disease. As a result, more and more clinicians are turning their attention to the evaluation and management of hepatitis C in an effort to prevent or slow down the progression to advanced liver disease. The following case history illustrates many of the complicated steps in the evaluation process of these patients. Several important issues are discussed, such as the rationale in performing a liver biopsy, when to initiate treatment, drug interactions, and adverse effects of therapy.