Successful treatment of hepatitis C in a patient with advanced AIDS and decompensated cirrhosis

Treatment of patients coinfected with HIV and hepatitis C virus is a challenging area for clinicians. We report on a treatment-naive man with advanced AIDS and cirrhosis secondary to hepatitis C, who has been followed from the initial diagnosis. After presentation, he began receiving HAART. During a disseminated Mycobacterium avium complex infection, massive ascites refractory to standard treatment developed. Substitution of nelfinavir for nevirapine in his antiretroviral regimen led to resolution of the ascites. Although excellent virologic control was achieved with HAART, the patient's immunologic response remained blunted until the hepatitis C was successfully treated. This case demonstrates that in some coinfected patients, hepatitis C can be successfully treated at low CD4 cell counts and that hepatitis C may influence the immunologic status of such patients.