Chronic hepatitis C (CHC) infection is a major co-morbidity seen in HIV patients. CHC infection adds to the burden of disease for the patient, and its treatment adds to the pill burden and adverse effects already experienced by the patient, as well as additional cost. Additionally, there is the potential for drug interactions, with a number of the antiretrovirals demonstrating pharmacokinetic interactions with other agents. With the advent of the NS3/4A protease inhibitors (PI) boceprevir and telaprevir, there is a need to assess the efficacy and safety/tolerability of PI-peginterferon-ribavirin (PR) triple therapy for CHC infection in patients who have HIV. The question of when to initiate therapy for CHC infection is a key issue associated with this condition. With PR therapy, SVR rates were typically higher in patients with minimal or no fibrosis, and decreased as patients progressed to cirrhosis. The dilemma in CHC is that not all patients will progress to serious complications such as cirrhosis or hepatocellular carcinoma. With the addition of protease inhibitors to PR therapy, it is important to determine whether response rates to triple therapy are impacted by baseline fibrosis status.
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