The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Hepatitis C in the HIV-Infected Person

Mark S. Sulkowski, MD; and David L. Thomas, MD
[+] Article, Author, and Disclosure Information

From Johns Hopkins University School of Medicine, Baltimore, Maryland.

Grant Support: In part by the National Institute on Injection Drug Abuse (DA-011602, DA-16078, and DA-13806).

Requests for Single Reprints: David L. Thomas, MD, MPH, Division of Infectious Diseases, Johns Hopkins University School of Medicine, 424 Bond Street, Baltimore, MD 21231; e-mail, dthomas@jhmi.edu.

Current Author Addresses: Dr. Sulkowski: Division of Infections Diseases, Johns Hopkins University School of Medicine, 1830 East Monument Street, Room 448, Baltimore, MD 21287-0003.

Dr. Thomas: Division of Infectious Diseases, Johns Hopkins University School of Medicine, 424 Bond Street, Baltimore, MD 21231.

Ann Intern Med. 2003;138(3):197-207. doi:10.7326/0003-4819-138-3-200302040-00012
Text Size: A A A

Because of shared routes of transmission, hepatitis C virus (HCV) infection is common in HIV-infected persons, who have been experiencing increasing HCV-related morbidity and mortality since the advent of effective antiretroviral therapy. Infection with HIV appears to adversely affect the outcome of hepatitis C, leading to increased viral persistence after acute infection, higher levels of viremia, and accelerated progression of HCV-related liver disease. In addition, hepatitis C may affect the course and management of HIV infection. The medical management of hepatitis C in HIV-infected persons is complicated by immune suppression, potential drug interactions and toxicities, and other forms of liver disease. In addition, there is little published experience with the safety and efficacy of the best available anti-HCV medications in HIV-infected persons. Thus, current efforts must be directed at preventing HCV and HIV infections and applying the principles learned in treating persons with either infection to manage those with both. Future efforts should include studies of the pathogenesis of HCV infection in HIV-infected persons and large, prospective studies that demonstrate the optimal management of persons co-infected with HIV and HCV. Such efforts will help to eliminate HCV-related liver disease as an emerging threat to HIV-infected persons.


Grahic Jump Location
Figure 1.
Prevalence of anti–hepatitis C virus (HCV) in HIV-infected persons receiving medical care in the Johns Hopkins HIV clinic (n= 1955) according to self-reported HIV exposure risk category.
Grahic Jump Location
Grahic Jump Location
Figure 2.
Clinical management of antiretroviral-associated hepatotoxicity in the person co-infected with hepatitis C virus (HCV) and HIV.Mycobacterium avium

Clinical management of antiretroviral-associated hepatotoxicity must be individualized. In addition, serious hepatotoxicity has been associated with the use of all available antiretroviral medications; the optimal use of these medications in persons with underlying liver disease has not been established. The long-term impact of mild to moderate elevations in liver enzyme levels on progression of HCV-related fibrosis is unknown, and the effectiveness of anti-HCV therapy for the suppression of drug-related liver toxicity has not been evaluated. *Based on reference 61. †Consider acute hepatitis A and hepatitis B virus infection, other infectious causes of hepatitis (for example, cytomegalovirus, Epstein–Barr virus, complex), acute cholecystitis, ethanol and other illicit drugs, other hepatotoxic medications (for example, fluconazole and trimethoprim–sulfamethoxazole), and nucleoside analogue reverse transcriptase inhibitor–related lactic acidosis syndrome due to mitochondrial toxicity. ‡ Patients with grade 3 or 4 hepatotoxicity and no symptoms of acute hepatitis who do not discontinue antiretroviral therapy should be monitored closely. ALT = alanine aminotransferase; AST = aspartate aminotransferase.

Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.