Special consideration for HCV/HIV co-infection is warranted, because up to 30% of HIV infected individuals are co-infected with HCV, and nearly all studies indicate that HIV accelerates progression of HCV to cirrhosis and liver failure. Preliminary studies indicate the safety of peginterferon and ribavirin to be comparable to HCV mono-infected patients, despite some early concerns about fatigue, anemia, and depression. Ribavirin should not be co-administered with didanosine because of increased tox-icity. Often, initiation of high active antiretroviral therapy in HCV/HIV co-infected patients will lead to a HCV disease flare from immune reconstitution injury or drug toxicity.
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