Emerging data support multiple derangements attending HIV coinfection, including increases in profibrogenic cytokine expression and secretion, generation of enhanced oxidative stress, and increases in hepatocyte apoptosis. Furthermore, liver-related death is a major cause of morbidity and mortality in HCV/HIV coinfected patients on antiretroviral therapy therefore, anti-HCV treatment is advised to be considered for all HCV/HIV patients. Unfortunately, treatment with pegylated interferon (PegIFN) plus ribavirin (RBV) has shown a low efficacy in these patients, mainly among those coinfected with genotype 1. Triple therapy with PegIFN plus RBV and telaprevir or boceprevir, the first approved direct-acting antiviral agents (DAAs) will improve the likelihood of cure for genotype 1 infected patients. Nevertheless, a significant number of coinfected patients are ineligible for IFN-containing regimens and concerns remain in regard with drug-to-drug interactions and safety of triple therapy in cirrhotic patients.
Furthermore, therapeutic decisions today need take into account the promise of new DAAs, some combined in IFN-free regimens, currently being investigated in multiple clinical trials to be in a near future, an easier, shorter and more effective HCV treatment in HIV coinfected patients.