Risk Factors for Progression of Hepatic Fibrosis in Patient Coinfected with HIV & Hepatitis C

 

Patient selection: coinfected with HIV and HCV

 

Risk factors for progression in liver fibrosis:

(1) failure to show a sustained hepatitis C viral response to regimen of interferon alpha and ribavirin

(2) concurrent therapy with didanosine

Situation	Recommendation
able to treat HCV before needing to treat HIV	treat HCV first, then start HIV therapy
must treat HCV and HIV simultaneously	use nucleoside reverse-transcriptase inhibitors with lowest mitochondrial toxicity

 

Anti-HIV drugs to avoid - dideoxynucleosides associated with mitochondrial toxicity:

(1) didanosine

(2) stavudine