Treatment controversies in HIV-HCV coinfection: Normal transaminases, therapeutic rescue and cirrhosis

The morbidity and mortality of Chronic Hepatitis C in HIV patients highlights the importance of active strategies of treatment. The improvement of risk-benefit balance may widen the indications of new anti-HCV therapies. Differences in the progression of the liver damage as well as its proper evaluation in HIV-HCV co-infection are still under investigation, making some therapeutical decisions controversial. For instance, whether or not patients with normal ALT levels must be treated depends on the real liver histology. Re-treatment after previous IFN failure must be advised if more potential virological efficacy with new Peg-IFN regimens still remains, but a possible histological benefit should also be considered. Finally, in non-decompensated cirrhosis, Peg-IFN plus Ribavirin represent nowadays the only alternative to a future liver trasplantation, although we must be cautious with more therapy related toxicity.