These data suggest an urgent need for the prevention and treatment of cirrhosis and HCC in HIV-infected persons. The Ioannou study4 identified five potentially modifiable risk factors for cirrhosis and/or HCC:HCV infection, hepatitis B virus (HBV) infection, diabetes, alcohol abuse, and low CD4+ cell count. 1 In this series, prevalence https://www.selleckchem.com/products/INCB18424.html of HCV infection decreased from 35% in 1996 to 25% in 20094; however, because HCV infection takes an average of 30-40 years to cause cirrhosis

or HCC, this decline might not result in a reduction of cirrhosis and HCC before 2026. Sustained virologic response (SVR) to anti-HCV treatment was associated, respectively, with a 39% and a 61% decrease in the probability to develop cirrhosis or decompensated cirrhosis. However, only 18% of HIV/HCV-coinfected patients received treatment and only 17% of them showed SVR.4 Preliminary AZD2014 purchase data from phase II pilot studies5, 6 have shown that the addition of boceprevir and telaprevir to pegylated interferon (IFN) and ribavirin results in increases of 50% in the rate of SVR in HIV-coinfected persons with HCV genotype 1. Nevertheless, given the low rate of treated patients, even a greater increase in efficacy of current treatment cannot significantly change these

outcomes. Barriers to treatment could probably be reduced by the availability of a pangenotipic all-oral, IFN-free, highly effective treatment. The results of pivotal proof-of-concept studies actually give a solid basis for this therapeutic perspective.7 In addition, testing for HCV is almost universal in persons living with HIV, thus a “test and treat” strategy could probably be developed in future years. The tools available to reduce the effect of HBV infection are already in our hands: vaccination and antivirals with dual anti-HIV and anti-HBV activity. It has demonstrated that in HIV-infected persons, HBV prevalence remained stable in the last 10 years,8 and the rate of new HBV infection is still 1.2 per 100 person-years.9 So, implementation of anti-HBV

vaccination in HIV-infected persons is still largely incomplete and should be pursued BCKDHA by all HIV-treating physicians. The low effect of HBV coinfection alone on cirrhosis in this study probably reflects the favorable effect of dual anti-HBV and anti-HIV therapy with lamivudine10 and/or tenofovir11 on the progression of chronic hepatitis B (CHB). However, several data recently showed the association between tenofovir exposure and bone or renal problems in HIV-infected persons.12 Withdrawal of anti-HBV therapy has been associated with a rapid progression of HBV in HIV-infected persons,13 so cost effectiveness of tenofovir withdrawal should be carefully evaluated in patients with CHB.