In HIV-coinfected patients delta virus may further accelerate the progression of liver disease [148]. For these reasons, patients with delta virus are candidates for treatment. However, evidence of treatment activity has been mostly obtained in HIV-negative patients. Interferon has been shown to be active [149,150]. In one study,

72 weeks of treatment with pegylated interferon alpha-2b was associated with sustained virological response (SVR) in about 20% of cases, and ribavirin did not add to this benefit [150]. There is a successful case report of the use of pegylated interferon alpha-2b for 72 weeks in a patient with HIV coinfection on HAART with undetectable HIV RNA [151]. In an earlier study, where standard interferon was used in 16 HIV-infected patients with HDV, the results were poor [152]. Palbociclib solubility dmso There are early efficacy data on tenofovir

use [153]. Test for delta virus in all patients with hepatitis B (III). There is now widespread recognition of the potential morbidity and mortality associated with HIV and HCV coinfection. Overall, the prevalence of HCV in the general UK population is estimated to be approximately 0.44% [154] but the rate varies by area and population and should be considered as a minimum. The highest risk groups for HCV infection are IDUs and people with bleeding disorders such as haemophilia [154]. Other risk groups Selleck LBH589 include sexual partners of injectors, prisoners, sex workers and children of HCV-infected

mothers. There may also be an increased rate in people who have had treatment or were born abroad and healthcare workers subject to sharps injury [154]. Although heterosexual transmission of HCV is uncommon, the higher levels of HCV RNA seen in the setting of HIV infection may facilitate transmission [154,155], particularly in the presence of other sexually transmitted infections such as infectious C-X-C chemokine receptor type 7 (CXCR-7) syphilis. This is of particular concern in the light of the recent rise of syphilis cases within the HIV community [1,3,156–161]. There have been reports from several European countries, Australia and the USA of hepatitis C transmission within the homosexual HIV community linked to possible sexual transmission and/or use of noninjecting recreational drugs, particularly snorting cocaine. The prevalence of HCV infection in HIV-positive individuals is higher than in the general population but varies among clinics according to risk factors for HIV acquisition. 5.1.2.1 The influence of HCV on HIV infection. HCV may have a deleterious effect on HIV progression. The Swiss HIV Cohort study and others demonstrated that HCV infection was independently associated with an increased risk of progression to AIDS or death, despite a similar use of antiretroviral therapies in the coinfected group compared with the group infected with HIV alone [162–164].