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Are there any challenges in HCV therapy of HIV infected patients left?

Direct acting antivirals (DAAs) have tremendously improved treatment of Hepatitis C virus (HCV) infections also in Human immunodeficiency virus (HIV) positive individuals. Curing HCV is of particular importance in HIV positive individuals as liver disease progression is accelerated in the course of concomitant HIV infection. Former challenges, such as safety and tolerability as well as reduced treatment uptake of a peginterferon (pegIFN) and ribavirin (RBV) based treatment have been overcome with the approval of DAAs. Indeed, rates of discontinuation under modern all oral DAA therapy in HIV/HCV coinfection have been reported to be less than 1%. Rates of sustained virological response (SVR) after treatment have aligned with those seen in HCV monoinfected patients, resulting in an equalization of treatment recommendations for HCV monoinfected and HIV/HCV coinfected patients. Nevertheless, coinfection with HIV has been associated with slightly higher relapse-rates in some real-world cohorts, arousing a discussion concerning a more individualized treatment once again. Moreover, an ongoing epidemic of acute HCV infections in HIV positive MSM with high reinfection rates challenges physicians and researchers. A concise summary of the remaining challenges in HCV treatment of HIV positive individuals is given in the present review.

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