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Is hepC now considered an opportunistic infection in those with HIV?
Jun 11, 2000

Hi Dr., I just came across this on the web and wondered if it's true (considered an o.i.) and what do you think of calling it one? "Many HIV positive patients have 'stable' HIV disease due to the widespread use of HAART (highly active antiretroviral therapy). Therefore, in the last 1-2 years, there have been reports that HIV positive patients increasingly are dying from liver disease often due to chronic hepatitis C and not from the "classical" AIDS opportunistic infections (OIs). Yet, chronic hepatitis C is now considered an AIDS OI. In the most recent update of the IDSA/CDC (Infectious Disease Society of America/Centers for Disease Control and Prevention) 1999 Guidelines for the treatment of opportunistic infections (OIs) in persons with HIV, chronic hepatitis C is now listed as an AIDS-defining illness. The updated Guidelines recommend that every HIV positive patient be tested for infection with HCV." If a person is hiv+ but never been on meds and has good counts (vl <400 cd4 589) also hepC+ (stage 3 fibrosis) would he be considered to have AIDS and an OI or HIV and an OI or what??? I'm mostly asking this because I think it can be helpful when filing for SSI since they want you to list any OI you have due to HIV. thanks for your input, Dr.

Response from Dr. Feinberg

Yes, it is true that we included hep C in the guidelines for treatment and prevention, but technically speaking, the definition of AIDS is set by the CDC and hep C is not included. That may be because the classic definition of an OI is an infection that takes advantage of a weakened immune system to cause disease. And hep C attacks people with normal immune systems all the time -- that is, it's not an opportunist, it's a virulent (disease-causing) pathogen (germ). HIV+s with hep C most often got the hep C before the HIV, when they still had intact immunity. The source of the confusion is that hep C (and B) are transmitted by the same behaviors that give you HIV, so many people are co-infected. We included hep C in the Guidelines because it is also true that now that we have decent therapy for HIV, people are living long enough to develop significant problems from their hep C.

You can still try to list hep C as a gambit for obtaining SSI, but I don't know if Social Security will recognize this as a "classic" OI.

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