Bani-Sadr et al identified risk factors for progression of hepatic fibrosis in patients coinfected with HIV and hepatitis C virus (HCV) and treated with interferon plus ribavirin. The authors are from multiple French universities in conjunction with the French National Agency for Research on AIDS and Viral Hepatitis.


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



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


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