Coinfection with hepatitis viruses and outcome of initial antiretroviral regimens in previously naive HIV-infected subjects.

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Abstract
POTENT COMBINATION antiretroviral therapies have changed the natural history of human immunodeficiency virus 1 (HIV-1) infection.1 However, longer patient survival leads to the emergence of hepatic comorbidity due to coinfections with hepatitis viruses, particularly hepatitis C virus (HCV).2,3 Significant proportions of HIV-1–seropositive patients, particularly injecting drug users, are coinfected with HCV, and others are chronically infected with hepatitis B virus (HBV).4,5 There is substantial evidence that HIV-1 infection and the related immunodeficiency negatively affect the natural history of chronic HCV and HBV infections, leading to increased replication of the viruses and more rapid evolution of liver fibrosis.6-11 It is still debated whether HCV coinfection might accelerate the natural history of HIV-1 disease or negatively affect the efficacy of antiretroviral therapy.4,12,13 Recent results from a cohort study14 have shown that, among patients beginning potent antiretroviral therapy, clinical progression of HIV and impaired recovery of CD4+ cells were associated with HCV seropositivity, independent of suppression of HIV-1 replication. Nevertheless, analyses of other cohorts did not confirm this observation.15,16 Therefore, this question needs to be further investigated in other large cohort studies of patients beginning potent antiretroviral therapies, preferably eliminating the bias of prior drug experience. It also remains to be analyzed in more depth whether HCV seropositivity is simply a marker of a patient group characterized by lower medication adherence or by a higher rate of toxicity associated with antiretroviral therapy, and whether observations made in HIV-1–seropositive subjects coinfected with HCV can be extended to those coinfected with HBV.