REVIEW ARTICLES Reciprocal Interactions Between Human Immunodeficiency Virus and Hepatitis C Virus Infections

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) share the same routes of transmission, which explains the high rate of HCV and HIV coinfection (-9%). HIV/HCV coinfec-tion leads to high rates of indeterminate recombinant immunoblot assay patterns and seroreversion; high levels of viral replication; and a more severe histopathologic course. By contrast, HCV infection does not seem to accelerate the progression of HIV infection. Interferon a (IFN-a) in coinfected patients leads to a similar rate of primary responses, but sustained responses are less frequent. The potential severity of hepatitis C virus infection evidences the need for early diagnosis. Liver biopsy should be performed for all HCV RNA —positive patients in order to evaluate the activity of the liver disease. Given the poor efficiency of IFN-a in terms of sustained response in HIV-infected patients, reinforced therapeutic procedures (long-term administration of IFN-a or combined ribavi-rin/IFN-a) should be proposed, at least for those patients with severe liver disease. Hepatotropic viruses that lead to chronic infection—namely, hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis delta virus (HDV), and HIV share the same parenteral, sex-ual, and vertical (from infected mother to newborn) routes of transmission [1, 2]. This common epidemiology explains the high frequency of combined infections by hepatotropic viruses and HIV. Little is known about interactions between HIV and HCV infections, while interactions between HIV and HBV [3-6] or HDV [7-10] have been extensively studied; these investigations have led to controversial findings, however. The aim of the present review is to clarify some important issues dealing with the reciprocal impact of HIV- and HCV-associated infections, including the variations in clinical, bio-logical, histopathologic, and virological natural history of both infections and the resulting therapeutic and prognostic conse-quences, on the basis of recent reports