Effect of alcohol use and highly active antiretroviral therapy on plasma levels of hepatitis C virus (HCV) in patients coinfected with HIV and HCV

Background. The interactions between human immunodeficiency virus (HIV), hepatitis C virus (HCV), alcohol, and antiretroviral therapy are complex. Methods. We retrospectively assessed persons coinfected with HIV and HCV who achieved HIV suppression to < 500 copies/mL and continued to take antiretrovirals for >= 6 months. Frozen plasma specimens were retrieved for quantitation of HCV RNA levels at baseline and 3, 6, and 12 months after beginning antiretroviral treatment. Results. Median HCV RNA levels increased (0.35 log(10) IU/mL) at month 3 (n = 44). HCV RNA levels decreased to below baseline by 12 months in patients consuming < 50 g of alcohol/day, whereas patients consuming >= 50g/day had a sustained increase (10.6 log(10) IU/mu L) from baseline (P = .04). Conclusions. Because low levels of HCV RNA are predictive of a virological response to therapy for HCV infection, it may be advantageous to first achieve suppression of HIV RNA and then initiate treatment for HCV infection in patients coinfected with HIV and HCV. Excess alcohol consumption with therapy for HIV infection increases HCV RNA levels and may impede the effectiveness of this treatment strategy.