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Less than 1% of HIV patients control HIV replication to an almost undetectable level without the aid of antiretroviral therapy (ARV), and are termed natural viral suppressors (NVSs)1. A recent study demonstrated that NVSs demonstrate immunological control toward HIV and not HCV or other chronic viral infections similar to HCV 2. The impact of effective immunological control of HIV replication in NVSs on response to Interferon-based immune therapy in HCV has not been studied. Studies have demonstrated that induction of host immunity is a key phenomenon associated with virologic response to IFN and ribavirin (RBV) treatment 3. In this regard, HIV/HCV co-infected patients have significantly lower host immune response and rates of sustained virologic response (SVR) to IFN/RBV compared to HIV negative, HCV infected patients4. Our study compares the effect of superior immunological control of HIV replication in NVSs to that in patients with chronic HIV (CHIV) on the clearance of HCV after treatment with IFN/RBV.

Hepatitis C virus infection is a major cause of liver disease, with 170 million persons infected worldwide. Hepatitis C virus is a ssRNA virus that preferentially infects human hepatocytes. Approximately 80% of HCV infections progress to chronicity, with development of hepatic fibrosis over time with 20% developing cirrhosis within 25 years, and 20% of these developing hepatocellular carcinoma. HCV remains the primary cause of liver transplantation worldwide. Of the 1 million people infected with HIV in the United States, about a third are co-infected with HCV. While cART has dramatically decreased the number of AIDS-related opportunistic infections, HCV- related liver disease has become leading cause of death in this population. HIV/HCV coinfected individuals have an accelerated progression of liver disease and lower therapeutic response rates when compared to their HCV mono-infected counterparts. In light of the higher rates of adverse events observed with current treatment in HIV/HCV coinfected patients, there remains a need for therapies with improved response rates, convenient dosing schedules, and safety profiles. Currently, the field of HCV therapeutics is evolving to rapidly develop strategies that are highly safe and efficacious for the eradication of HCV without the use of interferon formulations. Directly acting antivirals that target various stages of the HCV life cycle are being developed and will likely revolutionize the management of HCV by simplifying treatment, improving tolerability of regimens, and decreasing duration of therapy while maintaining or increasing rates of SVR. This presentation will discuss the newer therapeutics that are being developed for treating hepatitis C in HIV-infected subjects.