Initiatives Address Issues of HIV Co-infection, Prevention

Hepatitis C, a viral infection that principally affects the liver, is a blood-borne pathogen, generally transmitted through injection drug use. Approximately 15 percent of hepatitis C cases are transmitted through sexual contact, according to the CDC. Hepatitis C is a growing health risk, particularly for people with HIV/AIDS.

Although the rates of new infection have decreased from the 1980s, the CDC estimates that about 3.9 million people in the United States have hepatitis C. About 2.7 million of them are chronically infected. The CDC also estimates that one-fourth of people with HIV/AIDS also are infected with hepatitis C.

In an attempt to gain some perspective on effective prevention and treatment of hepatitis C, researchers and public health officials are planning a conference this fall to address these issues. The Forum for Collaborative HIV Research is sponsoring an Oct. 11 conference, "HIV/HCV Co-infection: Clinical and Research Challenges," in Washington, D.C. The goal of the conference is to learn what is known about the nature, prevalence and treatment of co-infection to better plan research for the future.

In a recent article in Infections in Medicine (18 (7): 349- 357, 2001), Dr. Michael A. Poles of the University of California, Los Angeles and Dr. Douglas T. Dieterich of Cabrini Medical Center in New York outlined the challenges and future outlook for people co-infected with HIV and hepatitis C.

Research so far, according to the authors, indicates that HIV co-infection accelerates the development of hepatitis C, but it is less clear what the effect of HIV infection is on the progression of HIV disease.

"Clinicians may be reluctant to prescribe antiretroviral medications in the presence of chronic viral hepatitis with or without elevations in levels of liver-associated enzymes," the article said. "Therefore, the presence of HCV infection significantly limits our ability to care for HIV-infected patients."

The authors said that the future of hepatitis treatment, which involves combination use of interferon and ribavirin, is bright for those with or without HIV/AIDS. And they contend that even more successful treatment of HIV will require better treatment of hepatitis C.

"Realistic expectations of long-term survival with HIV disease, especially with early diagnosis and combination antiretroviral therapy, demands consideration of therapy for concurrent chronic viral hepatitis," the authors wrote.

For public health officials, the priorities for the future are increased testing and counseling for hepatitis C. These efforts should include better coordination with existing clinical services and public programs, according to the CDC.

A recent survey of local health officials found that 87 percent of city and county health departments provide education about HIV/AIDS and 77 percent provide HIV testing. However, fewer than 50 percent provide hepatitis C counseling and only 23 percent provide hepatitis C testing.

CDC officials said that prevention should be expanded, especially for disenfranchised populations and those with health disparities, along with testing and prevention projects in correctional facilities.

Goals for a new National Hepatitis C Prevention Strategy launched by the CDC include:

• Identifying public health and clinical activities in which hepatitis C counseling and testing should be incorporated
• Ensuring training of health care professionals
• Developing the capacity to provide hepatitis C testing through public health or private diagnostic laboratories
• Identifying sources for appropriate medical referral of hepatitis C-positive persons
• Evaluating the effectiveness of hepatitis C prevention activities.

Back to other CDC news for September 24, 2001

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