Hepatitis C (HCV)
June 17, 2015
Most people who are infected with HCV do not know it because they have no symptoms. Early signs of HCV can seem like the flu and often go unnoticed. The only way to know for sure if you have HCV is to get a blood test for it. Testing for HCV is usually recommended based on a person's risk of infection or exposure to ways in which HCV is spread (see list above).
In addition, the CDC recently recommended that everyone in the US born during 1945 through 1965 (the "baby boomers") get a one-time blood test for HCV. This new recommendation has been released for a number of reasons, including improvements in treatment for hepatitis C and high rates of HCV infection among baby boomers. The Canadian Liver Foundation has made similar recommendations for testing all adults born between 1945 and 1975.
Tests for HCV include:
Women who are infected with HCV are different from HCV-infected men in a few important ways. First, the good news: women are more likely to clear HCV than men are. This means that when women become infected with HCV, their bodies are more successful at fighting it off. Women who develop chronic HCV infections are also more likely to get rid of HCV with treatment. Lastly, liver disease tends to progress more slowly in pre-menopausal women than in men.
However, women with HCV face a few extra challenges compared with HCV-infected men. First, women's livers are more sensitive to alcohol and are therefore more likely to be damaged by it in smaller amounts. The amount of alcohol women without HCV can drink without damaging their livers is smaller than men's. For women living with HCV, it is best to avoid alcohol altogether. For HCV-positive women who do drink, however, it is recommended that they not have more than one drink per day.
Secondly, women tend to be more likely to experience side effects when taking the drugs that have been the standard backbone of treatment of hepatitis C -- pegylated interferon and ribavirin. Specifically, depression and anemia are more common in women taking these drugs than in men. The good news is that several new HCV drugs in the development process now provide more effective treatment without having to take either interferon or ribavirin and so provide alternatives without these side effects.
It is also important for women to know that excess body weight can lead to fat in the liver. Fat in the liver increases inflammation and liver damage, and increases the risk of cirrhosis (scarring of the liver) in women living with HCV. Being overweight and having fat in the liver also lowers the chance of being able to get rid of HCV with treatment.
Because both HIV and HCV can be spread by contact with infected blood, many people are infected with both viruses. This is called co-infection. It is estimated that 12 million people worldwide are co-infected with HIV and HCV -- that's about one in three HIV+ people living with HCV. In the US, about one in four people living with HIV are co-infected with HCV. Co-infection is even more common among HIV+ injection drug users, of whom about eight out of ten also have HCV.
HCV can progress more rapidly and lead to serious liver damage more often in people living with HIV. According to the CDC, having HIV more than triples the risk of liver disease, liver failure, and liver-related death due to HCV. Pregnant women with HCV who are also living with HIV are two to seven times more likely to pass HCV on to their babies than HIV-negative women. Co-infection with HCV may also make HIV treatment more challenging.
For these reasons, it is important for people living with HIV to know whether they have HCV. The CDC recommends that all people living with HIV be screened for both hepatitis B and hepatitis C. Some experts recommend that HIV+ people at risk for HCV be screened every year.
Treatment of HIV/HCV co-infection is complicated. It is important to have a health care provider who is familiar with HIV and HCV to get the best treatment for both diseases. The good news is that HCV can be treated successfully, even in people living with HIV, and that there are several new and effective HCV drugs.
Recent research shows that waiting to treat HCV until a person has serious liver disease decreases the effectiveness of treatment and leads to poor health outcomes and higher likelihood of death. Moreover, we now know that HIV+ people are more likely to develop HCV-related liver damage and develop it faster than HIV-negative people. At CROI 2015, researchers showed that those people living with HIV and HCV who delay HCV treatment remain at risk for scarring of the liver (cirrhosis), liver cancer, and liver-related death, even after being cured of HCV. They also showed that the longer HCV treatment was put off, the worse the outcome.
In the past, when HCV treatment was based on taking interferon, experts often advised waiting, since treatment involved a long course of poorly-tolerated medication that often did not produce a cure. Now, however, there are several interferon-free treatment regimens with much higher success rates, even for people co-infected with HIV and HCV. These regimens are often referred to as DAAs, or direct-acting antiviral agents.
For more information about HCV treatment, see The Well Project's article Treatment of Hepatitis C.
Because there is no vaccine for HCV, the best way to avoid getting it is to understand how it is spread and protect yourself through safer sex and using clean needles when injecting. You can also keep your liver healthy by:
See The Well Project's article Caring for Your Liver for more information.
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.
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