Treatment of Hepatitis C in People Living With HIV
June 17, 2015
Unlike HIV, successful treatment can cure HCV. Treatment success is measured in different ways. End-of-treatment virological response means HCV is undetectable in the blood at the end of treatment. Sustained virological response, or SVR, means HCV is still undetectable six months after the end of treatment. After this, the virus rarely comes back, and people are considered cured.
Research has shown that Victrelis and Incivek increased HCV treatment success among HIV-coinfected people who had never taken HCV treatment. However, Incivek and Victrelis must be taken with interferon, and both drugs make the side effects of interferon worse. Therefore, taking this combination of HCV drugs is very difficult, especially given that Incivek and Victrelis are also likely to interact with HIV drugs.
Olysio has also proven effective among those co-infected with HIV and HCV. While it has fewer interactions with HIV drugs, it still has to be taken with interferon. Solvadi, on the other hand, is effective enough to be given with ribavirin only (no interferon) for co-infected individuals with genotypes 2 and 3.
Studies have shown that the two new HCV drug combinations of Daklinza + Solvadi and Harvoni -- both of which contain neither interferon nor ribavirin -- are highly effective in curing hepatitis C in people co-infected with HIV and HCV. After 12 weeks of treatment with the combination of Solvadi and Daklinza, 96 percent or more of co-infected people were cured of HCV. The same 96 percent cure rate was also seen in clinical trials of Harvoni. Notably, cure rates with Harvoni were lower among black individuals, and researchers are exploring why that was true.
The drugs that make up the Viekira Pak™ -- paritaprevir + ritonavir + ombitasvir, and dasabuvir -- have shown that they cure genotype 1 HCV in 90 to 100 percent of those who take it. The combination appears effective in those co-infected with HIV and HCV as well as in those with liver cirrhosis (scarring) and liver transplants.
People receiving HCV treatment should have their liver function tests and HCV viral load levels monitored regularly, since this can show how well treatment is working. If your HCV level has not started to drop after 12 weeks of treatment, it is unlikely that the treatment is working, and your health care provider will probably advise you to stop taking the drugs. Sometimes a second round of treatment can lead to a cure even if the first attempt was unsuccessful. This is especially true if the first attempt used an older combination of HCV drugs. The newer drugs -- Incivek, Olysio, Solvadi, and Victrelis -- have increased the effectiveness of HCV treatment significantly.
For people infected with both HIV and HCV, research has also shown that adhering to HCV treatment predicts the best chances of SVR, or curing HCV. Adherence to HIV drugs is very important in keeping viral loads low, avoiding resistance, and maintaining good immune system health. We now know that adherence to HCV drugs is similarly important for the successful treatment and cure of hepatitis C.
People infected with HIV and HCV face some special treatment issues. Basically, significant liver damage makes it harder to tolerate HIV drugs. At the same time, some HIV drugs can cause liver issues. Therefore, there is some debate about whether to start HIV or HCV treatment first. Generally, the benefits of being on HIV treatment outweigh concerns about liver injury from HIV drugs.
The current HIV treatment guidelines published by the US Department of Health and Human Services (DHHS) recommend that antiretroviral therapy for HIV be given to all co-infected people, regardless of CD4 count. However, since HCV treatment does not work well for co-infected people with CD4 cell counts below 200, HCV treatment is not recommended until their CD4 counts increase. For co-infected people who have never received HIV treatment and who have CD4 counts above 500, their providers may recommend delaying the start of HIV treatment until they have successfully completed HCV treatment.
The 2014 guidelines of the European AIDS Clinical Society (EACS) recommend that antiretroviral therapy for HIV be given to those co-infected people whose CD4 counts are less than 500.
The decision about which to treat first depends on many individual factors, including HIV viral load, CD4 cell count, and amount of existing liver damage. For this reason, it is important to see a health care provider familiar with both diseases whenever possible. As newer, improved HCV drugs are approved, barriers to treating HCV in the presence of HIV will drop as the benefits outweigh the consequences for more and more people.
In addition to medical treatment, there are steps you can take to keep your liver healthy, including:
Some herbs may help your liver, but others can cause serious liver damage. Be sure to tell your health care provider about any products you are taking, including over-the-counter or prescription medications, street drugs, herbal remedies, or nutritional supplements.
This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.