Hepatitis c virus activation in HIV-infected patients initiating highly active antiretroviral therapy

We describe repeated episodes of hepatitis C (HCV) activation associated with initiation of highly active antiretroviral therapy ( HAART) in two HIV/HCV coinfected individuals with undetectable serum HCV RNA. Both patients developed high HCV viremia (> 1 million IU/mL) and elevations in aminotransferases > 10 times upper limit of normal) within 4 months of starting HAART. This is the first report of clinically significant HCV activation in HCV-seropositive patients with initially undetectable HCV viremia. These observations suggest that flares of hepatitis C in the setting of the immune reconstitution inflammatory syndrome can occur even in those patients who have undetectable serum HCV levels prior to HAART initiation.