As the favourable polymorphism has a substantially higher frequency in European than African populations (75% vs. 40% respectively) this factor has been estimated to contribute to approximately half the difference in response rates between these racial groups. Testing for the IL28B polymorphism is not yet routinely available. However, future treatment regimens may be influenced and individualized according to the presence or absence of the polymorphism. HCV RNA should be assessed in

all HIV-positive persons as approximately 6% of these individuals fail to develop detectable HCV antibodies selleck kinase inhibitor so a negative antibody test result should not be interpreted as indicating that the patient does not have HCV infection [27]. Patients coinfected Kinase Inhibitor Library research buy with HIV and HCV have an approximately twofold greater risk of developing cirrhosis and progress more rapidly to liver failure compared with HCV monoinfected individuals [29]. The importance

of the need to treat HCV in this patient group should therefore be emphasized. To optimize response to anti-HCV treatment HIV infection should be fully suppressed using HAART. HAART regimens should not include zidovudine (AZT) as this is contraindicated with ribavirin because of the potential for severe anaemia [30]. Didanosine and stavudine should also be avoided because of the interaction with ribavirin and the risk of potentially fatal lactic acidosis [31]. There is oxyclozanide evidence that abacavir may be associated with poor treatment responses to HCV combination therapy because of an inhibitory effect on ribavirin so this should be considered if it is to be included in HAART regimens [32]. HIV non-progressors who are maintaining normal CD4 counts not on HAART should also be encouraged to undertake HCV treatment. Co-infected patients have lower SVRs with PegIFN/ribavirin treatment compared with monoinfected individuals. In the meta-analysis reported by Franchini co-infected patients had an overall SVR of 29% [26]. The indications for liver transplantation in HCV infected bleeding disorder patients who have progressed to end-stage

liver disease or have developed HCC are no different from other patients. HIV co-infected patients with non-progression of HIV infection or with stable disease on HAART should also be considered for transplantation [33]. All patients undergoing transplantation will acquire HCV infection in the new liver with a variable outcome in time. However, co-infected patients have a more rapid progression to fibrosis and a lower survival rate following liver transplantation than HCV monoinfected individuals [34]. New antiviral therapies including HCV nucleoside protease inhibitors (Telaprevir, Boceprevir), polymerase inhibitors and non-nucleoside polymerase inhibitors have been developed for use against genotype 1 virus and should become an integral part of eradication regimens in the near future [35].