Effects of Anti-HIV Therapy on Treatment for Hepatitis C in HCV/HIV Infected Adults

Inclusion Criteria for Step 1: * HIV infected * HIV viral load of greater than 1000 copies/ml within 45 days of study entry * HCV genotype 1 infected * CD4 count of 300 cells/mm3 or greater within 45 days prior to study entry * ART-naive or off ART for at least 6 months * Willing to accept randomly assigned study treatment * Willing to use acceptable forms of contraception during the study and for 6 months after stopping all study medications * Chronic liver disease consistent with chronic viral hepatitis as indicated by either liver biopsy within 2 years prior to study entry or a physician's report of hepatitis C infection for more than 6 months. Participants with cirrhosis or without a liver biopsy result within 2 years of study entry must have a serum alpha-fetoprotein of 100 ng/ml or less and a Child-Pugh score of 6 or higher within 45 days prior to study entry to be eligible for this study. Exclusion Criteria for Step 1: * Hepatitis B surface antigen positive within 45 days prior to study entry * HCV genotype other than genotype 1 at any time prior to study entry * Any medical conditions associated with chronic liver disease other than HCV (e.g., genetic hemochromatosis, autoimmune hepatitis) * Prior use of intravenous or subcutaneous interferon for more than 2 weeks total at any time prior to study entry * Known allergy/sensitivity to pegylated interferon alpha-2a, ribavirin, or their formulations * Current drug or alcohol abuse that, in the opinion of the investigator, may interfere with the study. Participants in methadone programs are not excluded, but may require methadone dose changes during the study. * Need to start ART at the time of study entry * Uncontrolled diabetes mellitus within 30 days prior to study entry * Previous suicide attempt or hospitalization for a psychiatric illness within 6 months prior to study entry. Participants with psychiatric disease, especially depression, uncontrolled with medication are not eligible for the study. * Prior or current evidence of immunologically mediated disease (e.g., inflammatory bowel disease, lupus erythematosus, autoimmune hemolytic anemia, scleroderma, severe psoriasis, rheumatoid arthritis) * Chronic pulmonary disease associated with functional limitation * Severe cardiac disease within 24 weeks prior to study entry * History of severe retinopathy due to diabetes, hypertension, cytomegalovirus, or macular degeneration * History of major organ transplantation * Severe illness, cancer, or other conditions that would interfere with the study * Any systemic antineoplastic or immunomodulatory treatment (except epoetin alfa or granulocyte colony-stimulating factor \[G-CSF\]) or radiation within 24 weeks of study entry. Participants who anticipate the need to begin such treatment during the study are not eligible. * History of hemoglobinopathy (e.g., thalassemia, sickle cell anemia) * Require certain medications * Evidence of decompensated liver disease, such as history or presence of ascites, jaundice, bleeding varices, or hepatic encephalopathy * Prior opportunistic infection or lowest ever CD4 count less than 200 cells/mm3 * Has a pregnant partner * Pregnancy or breastfeeding