Peer-review started: October 8, 2015
First decision: December 4, 2015
Revised: January 9, 2016
Accepted: January 29, 2016
Article in press: January 31, 2016
Published online: May 12, 2016
Processing time: 210 Days and 23.6 Hours
This review analyses current data concerning co-infection with hepatitis C virus (HCV) and human T lymphotropic virus (HTLV)-1/2 in people who inject drugs (PWID), with a particular focus on disease burden and global implications for virological outcome. In addition, the available treatment options for HTLV-1/2 are summarized and the ongoing and likely future research challenges are discussed. The data in this review was obtained from 34 articles on HCV/HTLV-1/2 co-infection in PWID retrieved from the PubMed literature database and published between 1997 and 2015. Despite unavailable estimates of the burden of HCV/HTLV-1/2 co-infection in general, the epidemiologic constellation of HTLV-1/2 shows high incidence in PWID with history of migration, incarceration, and other blood-borne infectious diseases such as HCV or human immunodeficiency virus. The most recent research data strongly suggest that HTLV-1 co-infection can influence HCV viral load, HCV sustained virological response to α-interferon treatment, and HCV-related liver disease progression. In short, outcome of HCV infection is worse in the context of HTLV-1 co-infection, yet more studies are needed to gain accurate estimations of the burden of HCV/HTLV-1/2 co-infections. Moreover, in the current era of new direct-acting antiviral treatments for HCV and proven HTLV-1/2 treatment options, prospective clinical and treatment studies should be carried out, with particular focus on the PWID patient population, with the aim of improving virological outcomes.
Core tip: People who inject drugs (PWID) are at higher risk of infection with blood-borne viruses and even co-infections. Co-infections with human immunodeficiency virus and human T lymphotropic virus (HTLV)-1/2 are common, and well-studied, among PWID; however, the rise of HTLV-1/2 co-infections with hepatitis C virus (HCV) has gained much research attention and studies have shown that the former influences the chronic disease course of the latter. This review summarizes the data from 34 articles on HCV/HTLV-1/2 co-infection in the PWID patient population, including current treatment options and impact on virological outcome.