Individuals with past resolved infection have positive anti-HCV antibody tests (usually by two different assays) with repeatedly negative HCV RNA tests and would be expected to have normal liver enzymes, in the absence of other causes of liver disease. Over time, anti-HCV antibody levels decline such that it can be difficult to differentiate infection in the distant past from nonspecific false positivity [183–187]. RNA levels may be transiently undetectable during acute infection so it is particularly

important to repeat HCV RNA tests in patients if the time at which they were initially infected is unknown [183–187]. With current assays, false negative antibody tests Selleckchem BAY 73-4506 IWR-1 cell line are rare in chronic infection but may be a problem in early acute infection [183–187]. Consideration should be given to HCV RNA testing of HCV antibody-negative HIV-positive individuals where: acute infection is suspected; (For the general principles of management, liver assessment and networks see the General section.) Patients should ideally be started on anti-HIV therapy when their CD4 count falls to 350 cells/μL or less (see General section). Prior to initiation of anti-HCV therapy, potential interactions and/or overlapping toxicities with anti-HIV therapies need to be considered. Where possible, anti-HIV therapies should be adjusted to Endonuclease enable optimal

administration of anti-HCV therapy, although this should never compromise anti-HIV drug efficacy. Consideration needs to be given to which antiretroviral agents should be coadministered with interferon and ribavirin therapy due to: drug interactions which may lower

antiretroviral drug levels, thereby raising concerns of reduced efficacy; The increasing availability of newer antiretroviral agents with improved safety profiles usually enables us to avoid such difficulties, but this may be less possible in heavily antiretroviral-pretreated patients. The key potential coadministration issues are summarized in Table 3. While there currently appear to be no theoretical problems with coadministration of interferon or ribavirin with the newer classes of antiretroviral drugs [integrase inhibitors, CCR5 blockers, and second-generation nonnucleoside reverse transcriptase inhibitors (NNRTIs)], clinical data to confirm this are awaited. When deciding to treat HCV, the choice of anti-HIV therapy should be agreed in association with an experienced HIV physician (IV). The main aims of therapy are to clear HCV and thereby limit liver disease progression and viral transmission. Antiviral therapy may also be helpful for those with extrahepatic manifestations of HCV such as cryoglobulinaemia [193]. An SVR is defined as a negative HCV RNA PCR test 6 months following cessation of therapy.