Hepatitis C and HIV

Liver problems are common in people living with HIV, be they caused by HIV, drug side effects or other conditions (like hepatitis). Hepatitis is a medical term that means inflammation or swelling of the liver. A virus that attacks the liver can cause hepatitis. There are more than fives types of hepatitis viruses (A through E and G) that can be transmitted through sexual contact, contaminated foods, blood and/or other body fluids.

The majority of liver disease in people with HIV is caused by viruses, especially hepatitis B (HBV) and hepatitis C (HCV). Other common HIV-related conditions that can affect the liver include cytomegalovirus (CMV), Epstein-Barr virus (EBV), Mycobacterium avium complex (MAC), toxoplasmosis and histoplasmosis. In addition, many medications used to treat HIV can cause liver problems as a side effect.

Hepatitis C is a major concern that many women living with HIV face. This issue of Wise Words focuses on HCV and provides information on diagnosing, treating and living with HCV. For more information about the common forms of viral hepatitis, call our hotline at 1-800-822-7422.

Spotlight on HCV

HCV is transmitted through sharing needles, needle sticks, blood transfusion, organ transplantation or from mother-to-child during child delivery. It may also be spread through sexual contact. Ways to prevent becoming infected with HCV include safer sex practices and making sure needles are sterilized before use. This includes needles used for acupuncture, tattooing and body piercing. There is no vaccine against HCV.

Symptoms of HCV infection can occur 2-8 weeks after initial infection. However, most people infected with HCV may experience little to no symptoms. When symptoms do occur, they can include flu-like symptoms (such as fever, fatigue, muscle and joint pain, nausea and vomiting), dark urine, loss of appetite, stomach pain, diarrhea and nausea.

In a small percentage of cases (15%), HCV infection is cleared spontaneously. But in most cases, HCV infection becomes chronic (lasts for 6 months or more) and slowly damages the liver. Over time, liver damage can lead to serious consequences, including scarring of the liver (cirrhosis) and liver cancer.

When the liver is damaged it will try to repair itself which forms small scars, a process called fibrosis. A greater amount of fibrosis can indicate more severe and more advanced disease.

As liver cells are damaged or die, they release high amounts of certain enzymes into the blood. Two important enzymes are ALT (alanine aminotransferanse) and AST (aspartate aminotranferase). High levels of these enzymes may indicate liver damage. Often times, by the time HCV is diagnosed, the liver is already damaged. HCV, like HIV, is very difficult to treat because it can mutate quickly and escape the natural immune response.

Symptoms of chronic HCV infection can be very minor to non-existent and may be infrequent. They can include joint pain, fatigue, nausea and loss of appetite. Symptoms of end-stage liver disease can include fatigue, muscle weakness, nausea, weight loss, dark urine, fluid retention and loss of appetite. In addition, the liver or spleen may be enlarged, which can cause yellowing of the skin and eyes (jaundice), muscle wasting, swelling of the ankles and accumulation of fluid in the stomach area, called ascites.

There are several types of HCV, called genotypes. The most common genotype in the U.S. is genotype 1. Genotype 1 is less responsive to treatment and a person may need to stay on treatment longer.

Antibody tests are initially used to diagnose HCV. These tests detect the presence of antibodies (an immune response to the virus), specific for HCV. There are two kinds of tests: ELISA or EIA (Enzyme-linked immunosorbent assay) and RIBA (Recombinant immunoblot assay).

Usually an EIA will be done first. The RIBA will be done to confirm the presence of HCV antibodies. Antibody tests do not tell whether the infection is acute (new), chronic (long-term) or completely cleared. If an ELISA test is positive, that means that you have been exposed to HCV, but it doesn't tell you if your body cleared the infection or if has established as a chronic infection.

HCV viral load tests directly measure the amount of HCV in the blood and are primarily used to determine if treatment for HCV is working. Unlike viral load tests for HIV, HCV tests are not as useful in predicting the severity of or risks for disease progression. So HCV viral load tests are not used when considering when to start treatment. In most people with HCV who are not on HCV treatment, viral load can range from 100,000-10,000,000 copies per milliliter of blood (in a teaspoon of blood). A high viral load is considered anything greater than 2 million copies/ml.

Negative HCV test results can occur in people living with HIV who are actually infected with HCV, as their immune systems may not be producing enough antibodies.

Some studies have suggested that people living with both HCV and HIV have higher HCV levels and may progress to HCV-related liver disease, such as liver cancer, faster than people who are only HCV-positive. On the other hand, there are conflicting reports as to whether HCV has any impact on HIV levels or disease progression, although one large study found that people with both HIV and HCV who started anti-HIV therapy had a much smaller rise in CD4+ cell counts compared to people only infected with HIV.

Following are information and tools for considering whether HCV treatment is right for you, factors to consider when making a decision and the risks and benefits to treating and not treating.

Back to the Project Inform WISE Words August 2003 contents page.