TITLE:
Antiretroviral Therapy in HIV/HCV Co-Infection Italian Consensus Workshop
AUTHORS:
Paola Nasta, Anna Maria Cattelan, Ivana Maida, Francesca Gatti, Erika Chiari, Massimo Puoti, Giampiero Carosi
KEYWORDS:
ART; HIV/HCV; Co-Infection; Liver Toxicity
JOURNAL NAME:
Advances in Infectious Diseases,
Vol.3 No.2,
June
7,
2013
ABSTRACT:
About 50% of people living with the HIV infection in Italy are
co-infected with HCV. In this group of patients, the primary cause of mortality
is liver disease, which accounts for up to 14% of deaths. HIV/HCV co-infection
also exposes patients to a higher risk of progression to AIDS, a faster
evolution towards cirrhosis, more frequent drug toxicity, and lower tolerance for
antiretroviral therapy. Moreover, HCV infection can play a part in increasing
immune system depression; neurological, cognitive and renal damage; and bone
fragility. Hence an optimal antiretroviral regimen needs to be chosen for
co-administration with anti-HCV therapy and timed appropriately to improve the
prognosis of co-infected HIV/HCV patients. Unfortunately, however, data on the
safety and efficacy of antiretroviral drugs in these patients is scarce, as are
studies of pharmacokinetics in patients with advanced liver impairment.
Furthermore, restoring adequate immune constitution seems not to slow the
progression of liver disease, and the metabolic and hepatic toxicity of some
antiretroviral drugs can even contribute to inflammatory and fibrogenic processes.
It is therefore essential that HIV/HCV co-infected patients receive only
medications capable of ensuring the best immune recovery but possessing the
lowest potential to trigger immune reconstitution syndrome or hepatic and metabolic
damage.