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Guide to Hepatitis C for People Living With HIV
Testing, Coinfection, Treatment and Support

By Simon Collins and Tracy Swan

August 2007

Managing Cirrhosis

A damaged liver can still function, but people who have developed cirrhosis are at risk for liver failure and other serious, life-threatening complications. People with compensated cirrhosis should be screened for liver cancer and monitored regularly for decreasing liver function and varices (stretched and bursting veins). Beta blockers can help prevent varices. Variceal hemorrhaging is managed with medication and surgery.

Changing your diet may help to manage some of the complications of cirrhosis. Cutting down on salt and eating many small light meals per day, with protein from vegetables and dairy products rather than meat, can help redress nutritional imbalances. A nutritionist and your doctor can help you plan a healthy diet.

When liver function has deteriorated and hepatic decompensation occurs, a liver transplant is necessary.

Liver Transplant in People With HCV/HIV Coinfection

In people with severe decompensated liver disease, a liver transplant is the final option.

This is a major operation, and success rates vary. It is also complicated by a scarcity of donor organs that are available for transplant.

For many years, transplant services actively avoided transplanting organs into HIV-positive people. This was due to several factors: discrimination from some surgeons, who did not want to operate on HIV-positive people; the poor long-term prognosis for HIV-positive people before effective HIV treatment was available, which meant that a donor organ would provide fewer years of additional life than it might to a person without HIV or other medical conditions, and concerns about using immunosuppressive drugs in HIV-positive people.

The effectiveness of HIV drugs has changed this. HIV is no longer an exclusion criteria for transplantation. Centers in the US, Spain, France, and the UK have transplanted livers into HIV-positive candidates. Results have been mixed; some centers have reported no significant difference in survival according to HIV status, but medical management remains complex due to drug interactions between immunosuppressants and protease inhibitors, graft rejection, recurrent HCV, and difficulty in tolerating HIV and HCV treatment after transplantation.

Since HCV infection progresses more rapidly in people with HIV coinfection, some specialists suggest that people with coinfection should be referred to transplant lists at a slightly earlier stage of disease than people with HCV monoinfection.

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