Hepatitis C Virus (HCV) & HIV
Several workshops discussed HIV and Hepatitis C virus (HCV) infection in women (HIV/HCV co-infection). In most people, HCV infection becomes chronic (ongoing). Over long periods of time, chronic infection with HCV can lead to life-threatening liver disease and liver cancer. This can occur in people living with either HIV/HCV or HCV alone.
HCV and Liver DiseaseBecause we don't yet have long-term studies of the outcome of HCV, it's not possible to estimate the percent of people who will develop serious liver disease over their lifetimes. Researchers fear that the high chronic infection rate signals a more troubling long term forecast. Studies have shown that people with HIV and HCV appear to develop early stage liver disease more rapidly than HIV-negative people. This increase hints at a worsened overall outlook for people living with HIV and HCV.
What Treatments Are Available?Treatment for HCV exists, but there's controversy over when to use it and who might best benefit. The current standard of treatment uses a combination therapy that includes interferon-alpha (an injectable drug) and ribavirin. This combination produces better results than interferon alone.
Both anti-HCV drugs have potential side effects. Interferon-alpha side effects include moderate to severe flu-like symptoms. Ribavirin can cause a decrease in red blood cells, called anemia (click here for more on anemia). Since ribavirin can also cause birth defects, it should not be used during pregnancy. Women and men using ribavirin are advised to wait at least six months after ending therapy before trying to have children. Depression is another condition to be aware of though it can be confusing whether depression is a side effect of anti-HCV therapy or a symptom of HCV itself.
When to Start TreatmentWhen to start treatment is even more controversial in HCV than it is in HIV. If liver function tests (LFTs) are consistently three to five times the "normal" range, discuss with your doctor the possible causes of the higher LFT values. See whether other tests, such as a liver biopsy, might be justified to help determine the need for anti-HCV therapy. Currently, liver biopsy results are regarded as the best way to decide when to start HCV therapy.
Although viral load tests for HCV are also available, it's unclear how to best use the results of this test in making treatment decisions. Also, before starting therapy, it can be valuable to take a test to determine which "type" of HCV you have. Though people with HCV type 1 (the most common in the US) are least likely to benefit from current anti-HCV therapy, some can still benefit from treatment. Speak with your doctor about what your liver biopsy, viral load tests and HCV type mean for you and your health.
Treatment DecisionsHCV treatment poses many challenges to someone living with HIV and HCV. Some people may find it hard to integrate anti-HCV therapy into their lives, particularly if they are also taking anti-HIV therapy. The significant side effects of anti-HCV therapy can make family and work life difficult without assistance. People with HIV and HCV may also choose not to treat HCV because the success rate of therapy is low and the course of treatment long (48 weeks). This is particularly the case in people with HCV type 1.
Some providers have biases against HCV treatment for a person with a history of substance use/abuse. The ritual of injecting anti-HCV drugs, coupled with the potential side effect or occurrence of depression, may trigger relapses in substance use/abuse. People considering anti-HCV therapy should discuss this with their providers and people they trust.
CommentsThere's a dire need for studies to better understand HIV and HCV co-infection. Some studies shows that women are more likely to benefit from anti-HCV therapy then men. However, other studies show that African Americans may fare less well than whites. It is unknown whether this is the case for African American women.
More effective and less toxic therapies are needed. If you're co-infected with HIV and HCV, seek out a doctor who's knowledgeable about both viruses, if possible. For more information about HCV treatment, call the Project Inform Hotline and ask for the Hepatitis Fact Sheet. Also, in a future issue of WISE words, HIV/HCV co-infection treatment issues will be discussed further -- so stay tuned.
This article was provided by Project Inform. It is a part of the publication WISE Words. Visit Project Inform's website to find out more about their activities, publications and services.