Session 24
Symposium: Emerging Issues in Hepatitis C Infection

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• S8: Epidemiology and Natural History of Hepatitis C (David Thomas, Johns Hopkins Univ., Baltimore, MD)
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• S9: Molecular Virology of Hepatitis C: An Overview (Charles Rice, Washington University School of Med., St. Loius, MO)
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• S10: The Immunopathogenesis of Hepatitis C Virus (Margaret Koziel, Beth Israel Deaconess Med. Ctr., Harvard Med. Sch., Boston, MA)
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• S11: The Treatment of Chronic HCV Infection in HIV-Infected Persons (Mark Sulkowski, Johns Hopkins Univ., Baltimore, MD)
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This two-hour symposium reviewed the current knowledge of hepatitis C infection and treatment. The first talks reviewed very sophisticated studies of how hepatitis C virus replicates in the body, and the immune system's response to hepatitis C infection. While most people in the world are infected by hepatitis C through exposure to dirty needles, many people seem to acquire the infection through sexual exposure. While the NIH guidelines do not recommend that people who are hepatitis C infected need to practice safe sex, if in a stable monogamous relationship, that data is based only on studies of heterosexual couples. There may, in fact, be a significant risk of transmission of hepatitis C through anal sex, but we do not know. However, it is known that only about 15% of people infected with hepatitis C get rid of the infection on their own, but many people live many years before ever getting sick.

An excellent review of the reaction of the immune system to hepatitis C was presented by Margaret Koziel, from Boston. While a brisk immune response to hepatitis C may initially help eliminate the infection, it appears that later in the course of hepatitis C infection, the immune response may be what causes most of the liver damage, rather than the virus itself.

Mark Sulkowski, from Baltimore, reviewed the current treatment data for hepatitis C infection. The best results of treatment have been seen using the combination of interferon and ribaviran. However, ongoing studies of a new long acting interferon, pegylated-interferon, and ribaviran are quite promising. The new interferon needs only be administered once a week, compared to three-to-five times a week with the older form of interferon. Sulkowski, also discussed some of the early data using the combination of interferon and ribaviran in treating people infected with both hepatitis C and HIV. Dr. Sulkowski recommended that treatment of hepatitis C should be considered in the following groups of HIV-positive people:

• Stable HIV with good CD4 counts, where it may be possible to eradicate hepatitis C.

• People with advanced liver disease, such as cirrhosis, where treatment may slow the progression of hepatitis C liver damage.

• People who are experiencing recurrent liver toxicity when HIV treatment is administered.

Please note: Knowledge about HIV changes rapidly. Note the date of this summary's publication, and before treating patients or employing any therapies described in these materials, verify all information independently. If you are a patient, please consult a doctor or other medical professional before acting on any of the information presented in this summary. For a complete listing of our most recent conference coverage, click here.