Should Treatment of HIV infection precede, follow or be concurrent with therapy for HCV?
There is no available peer reviewed literature upon which to make firm recommendations. Until such data can be gathered, all co-infected patients should be encouraged to initiate HCV therapy within the context of a cohort or randomized controlled clinical trial where available. The theoretical basis for initial management of HCV is based on the concern of the hepatotoxicity of many of the antiretroviral agents in current use, which could be more marked in the presence of HCV [56,57]. However, it remains unclear whether prior therapy for HCV can decrease subsequent toxicity to HIV medications. In addition, the immune restoration associated with HAART therapy could lead to an increase in the immunologic response against HCV and potential worsening of the liver disease [58,59]. In contrast, the beneficial effects of management of HIV have been demonstrated in controlled clinical trials, and should not be deferred to treat HCV first, if HIV treatment is indicated. Recommendations: In gener
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