Towards a decline in hepatitis related mortality in persons living with HIV?

Liver related mortality is the second cause of death in persons living with HIV (PLHIV) in developed countries; it has showed a stable trend since from 2000, but a decline of HBV related mortality has been observed during this time period probably because of the large usage of anti HIV drugs with dual anti HBV and anti HIV activity. Hepatitis C coinfection is the main cause of liver related death, but its prevalence in PLHIV in Italy is declining. HIV worsens the course of HCV, but this effect could be reduced by early HAART. The negative effect of HAART in the short term (hepatotoxicity) and long term (steatosis, insulin resistance) could be reduced by the usage of new antiretrovirals. Optimization of anti HCV treatment by: response and human genotype guided therapy, usage of higher doses of Ribavirin, selection of concurrent HAART and pre-treatment management of metabolic side effects of HAART might increase the rate of SVR and patients survival. Screening of cirrhotics for HCC, aggressive treatment of decompensated cirrhosis and liver transplantation might increase survival in patients with advanced liver disease. In the next future the implementation of new anti HCV drugs in clinical practice, by increasing the rate of response to treatment, could additionally improve the prognosis of HIV/HCV coinfected patients.
Keywords: HCV; HBV; HIV; Cirrhosis; Hepatocellular Carcinoma; Interferon; Ribavirin.

Articolo presente in – HAART and correlated pathologies n. 7

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