Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jul 28, 2015; 7(15): 1936-1952
Published online Jul 28, 2015. doi: 10.4254/wjh.v7.i15.1936
Hepatitis C in human immunodeficiency virus co-infected individuals: Is this still a “special population”?
Drosos E Karageorgopoulos, Joanna Allen, Sanjay Bhagani
Drosos E Karageorgopoulos, Joanna Allen, Sanjay Bhagani, Department of Infectious Diseases/HIV Medicine, Royal Free London NHS Foundation Trust, London NW3 2QG, United Kingdom
Sanjay Bhagani, Research Department of Infection, UCL Medical School, Royal Free Hospital, London NW3 2QG, United Kingdom
Author contributions: Karageorgopoulos DE and Allen J equally contributed to the work; Bhagani S contributed to the work also.
Conflict-of-interest statement: Karageorgopoulos DE and Allen J: There are no conflicts of interest. Bhagani S has received honoraria/speakers fees and travel grants from Abbvie, BMS, Gilead, Janssen, MSD and ViiV.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Dr. Sanjay Bhagani, BSc, MB, ChB, FRCP, Department of Infectious Diseases/HIV Medicine, Royal Free London NHS Foundation Trust, Pond Street, London NW3 2QG, United Kingdom.
Telephone: +44-20-77940500-36285 Fax: +44-20-78302730
Received: February 11, 2015
Peer-review started: February 12, 2015
First decision: March 20, 2015
Revised: June 24, 2015
Accepted: July 21, 2015
Article in press: July 23, 2015
Published online: July 28, 2015

A substantial proportion of individuals with chronic hepatitis C virus (HCV) are co-infected with human immunodeficiency virus (HIV). Co-infected individuals are traditionally considered as one of the “special populations” amongst those with chronic HCV, mainly because of faster progression to end-stage liver disease and suboptimal responses to treatment with pegylated interferon alpha and ribavirin, the benefits of which are often outweighed by toxicity. The advent of the newer direct acting antivirals (DAAs) has given hope that the majority of co-infected individuals can clear HCV. However the “special population” designation may prove an obstacle for those with co-infection to gain access to the new agents, in terms of requirement for separate pre-licensing clinical trials and extensive drug-drug interaction studies. We review the global epidemiology, natural history and pathogenesis of chronic hepatitis C in HIV co-infection. The accelerated course of chronic hepatitis C in HIV co-infection is not adequately offset by successful combination antiretroviral therapy. We also review the treatment trials of chronic hepatitis C in HIV co-infected individuals with DAAs and compare them to trials in the HCV mono-infected. There is convincing evidence that HIV co-infection no longer diminishes the response to treatment against HCV in the new era of DAA-based therapy. The management of HCV co-infection should therefore become a priority in the care of HIV infected individuals, along with public health efforts to prevent new HCV infections, focusing particularly on specific patient groups at risk, such as men who have sex with men and injecting drug users.

Keywords: Human immunodeficiency virus, Hepatitis C, Coinfection, Antiviral agents, Anti-retroviral agents, Natural history, Epidemiology, Pathogenesis, Therapy

Core tip: This manuscript focuses on hepatitis C virus/human immunodeficiency virus (HIV) co-infection, two intersecting epidemics with great global health interest. It reviews the epidemiology, pathogenesis and natural history of chronic hepatitis C in HIV infected individuals. It also reviews the impact of antiretroviral therapy on the natural history of chronic hepatitis C and the liver. Moreover, it shows that the outcomes of treatment with the newer direct acting antivirals against hepatitis C are similar in the mono-infected and co-infected patients, providing informative data extracted from relevant clinical trials. It argues that HIV infected individuals should no longer be designated as a “special population” among those with chronic hepatitis C, as this could delay their access to the new treatments.