Evaluation of the HIV-infected patient with chronic hepatitis C virus infection
- Arthur Y Kim, MD, FIDSA
Arthur Y Kim, MD, FIDSA
- Assistant Professor of Medicine
- Harvard Medical School
As death rates from opportunistic infections in HIV-infected patients have declined with the introduction of potent antiretroviral therapy (ART), morbidity and mortality from end-stage liver disease has increased. These clinical observations provide strong rationale for the evaluation and treatment of the HIV-infected patient with chronic hepatitis C virus (HCV) infection.
The HIV/HCV-coinfected patient benefits from a multi-disciplinary team approach and intensive support throughout treatment. The complexities of hepatitis C management in this patient population will be reviewed here. The epidemiology, natural history, diagnosis, and treatment of HCV in the HIV-infected patient are discussed elsewhere. (See "Epidemiology, natural history, and diagnosis of hepatitis C in the HIV-infected patient" and "Treatment of chronic hepatitis C virus infection in the HIV-infected patient".)
History — HIV-infected patients who are being seen for evaluation and possible treatment of hepatitis C should undergo a complete history and physical examination.
Substance abuse — Patients with a history of substance abuse who are currently abstinent should be interviewed about the stability of their recovery since the use of interferon has been associated with relapse of drug use . Active injection drug use does not rule out the possibility of treatment; rather decisions about offering therapy should be based on the patient's ability to adhere to medications, return for follow-up, and avoid reinfection (eg, avoidance of sharing needles) [2,3]. Treatment of addiction with drugs such as methadone or buprenorphine can effectively facilitate HCV treatment in drug users. (See "Treatment of chronic hepatitis C virus infection in the HIV-infected patient".)
Alcohol use should also be detailed; coinfected patients should be counseled against the use of alcohol, which has been associated with acceleration of disease progression in patients with HCV infection . Furthermore, CD4 counts may improve after patients stop drinking alcohol . (See "Epidemiology, natural history, and diagnosis of hepatitis C in the HIV-infected patient".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- INITIAL EVALUATION
- - Substance abuse
- - Psychiatry history
- - Other past medical history
- - Medication history
- - Social history
- - Pregnancy
- - Family history
- - Sexual history
- Physical examination
- Laboratory screening
- Screening for tuberculosis
- Interpretation of aminotransferases
- Patients with suspected cirrhosis
- STAGING OF LIVER DISEASE
- Role of the liver biopsy
- - Advantages
- - Limitations
- - When should a liver biopsy be obtained
- - When should a biopsy be repeated
- Noninvasive serum fibrosis markers
- Transient elastography
- IMAGING STUDIES
- - Screening for hepatocellular carcinoma
- CT scanning
- SOCIETY GUIDELINE LINKS
- SUMMARY AND RECOMMENDATIONS