Table of Contents
Hepatitis C for People Living With HIV

• Introduction
  • Personal accounts
  • Web edition contains extra information
  • Controversial aspects of hepatitis C
• First Questions
  • What is hepatitis C?
  • How did I get hepatitis C?
  • How serious is hepatitis C?
  • Will hepatitis C make my HIV worse or more difficult to treat?
  • How common is HIV/hepatitis C coinfection?
  • What should I do first after a hepatitis C diagnosis?
  • Who should I tell?
• Newly Diagnosed With Hepatitis C
  • Newly diagnosed with both HIV and hepatitis C at the same time
  • Are people around me now at risk?
  • Can I pass on hepatits C through sex?
  • Can you catch another type of hepatitis C or HIV?
  • About hepatitis viruses
  • Hepatitis A and B
  • About hepA and hepB vaccination
• Hepatitis C Transmission
  • How hepatits C is caught and passed on
  • Hepatitis C, blood products and blood transfusions
  • Injecting drug use and hepatitis C
  • Hepatitis C and other (non-injecting) drug use
  • HIV, hepatitis C and sex
  • Heterosexual transmission of hepatitis C
  • Sexual transmission of hepatitis C in HIV-positive gay men
  • Crystal meth, ecstasy, coke and hepatitis C
  • Mother to child transmission of hepatitis C
• Natural History of Hepatitis C
  • Acute infection (0-6 months)
  • Chronic infection (6+ months)
  • End stage liver disease
  • Factors that accelerate hepatitis C progression
  • Hepatitis C and your liver
  • What does your liver do?
  • How does hepatitis C damage your liver?
  • How can you protect your liver?
  • Hepatitis C outside the liver
  • HIV and hepatitis C coinfection
  • Effect of hepatitis C on HIV
  • Hepatitis C progression in HIV-positive people
• Issues Affecting Specific Individuals
  • Introduction
  • New hepatitis C infections in HIV-positive gay men
    • Risk factors
    • Responses to a hepatitis C diagnosis
    • Advantage of detecting acute hepatitis C infection
    • Living with hepatitis C
  • Long-term coinfection from blood products and injecting drug use
    • Hepatitis C transmission to sexual partners
    • Hepatitis C treatment in long-term infection
    • Access to treatment for drinkers and drug users
• Tests and Monitoring
  • Tests to diagnose hepatitis C
  • Routine blood tests
  • Hepatitis C viral load (RNA testing)
  • Hepatitis C tests and what the results mean
  • Hepatitis C genotype
  • Predominant hepatitis C genotype by region
  • Liver enzyme tests: ALT and AST
  • Other liver enzymes: ALP, GGT, bilirubin, albumin and prothrombin time
  • Screening for liver cancer in people with cirrhosis
  • Lab results record sheet
  • Lab results: reference ranges for men and women
  • Liver biopsy
  • When is a biopsy important?
  • Interpreting biopsy results
  • Alternatives to a biopsy: non-invasive biomarkers of liver disease
• Hepatitis C Treatment and Management
  • Hepatitis C treatment: how, why, when
  • Who needs treatment?
  • How is hepatitis C treated?
  • What is pegylated interferon?
  • How long is hepatitis C treated for?
  • Goals of hepatitis C treatment
  • Predicting the response to treatment
  • Hepatitis C treatment and HIV coinfection
  • When should HIV be treated first?
  • When should hepatitis C be treated first?
  • Hepatitis C treatment and CD4 cell count
  • HIV treatment concerns in people with coinfection
  • Drug interactions between hepatitis C treatment and HIV meds
  • How well does treatment work?
  • Evaluating response to hepatitis C treatment
  • Hepatitis C treatment timeline for people with HIV
  • Hepatitis C treatment and injecting drug users
  • Concerns for people in recovery
  • Retreating hepatitis C
  • Management of cirrhosis
  • Liver transplant in people with HIV/hepatitis C coinfection
• Side Effects and Management Strategies
  • Side effects overview
  • Liver toxicity and HIV drugs
  • Therapeutic drug monitoring (TDM)
  • Depression, anxiety, and other psychiatric side effects
  • Flu-like symptoms, weight loss and fatigue (feeling tired)
  • Anaemia, neutropenia and thrombocytopenia
  • Insomnia, rash, dry mouth, breathlessness, irritability and other side effects
• Deciding Whether to Treat Hepatitis C
  • Treatment tips
  • Advantages of using hepatitis C treatment
  • Advantages of delaying treatment
• Research Into New Hepatitis C Drugs
  • Where to get information on new hepatitis C drugs
  • Discussion
• Living With Coinfection
  • Overview
  • Stress
  • Alcohol
  • Alcohol and liver damage
  • Tips for reducing or avoiding alcohol
  • Recreational drugs
  • Smoking
  • Body fat and body weight
  • Body mass index
  • Diet
  • Herbal medicine
  • Research on herbal medicine
• Other Viral Hepatitis Infections
  • Hepatitis A
  • Hepatitis B
  • Other viral hepatitis infections
• Controversial Aspects of Hepatitis C Transmission, Monitoring, Care and Treatment
  • Sexual transmission
  • Safety of light-to-moderate alcohol intake
  • Liver biopsy
  • Access to treatment for drinkers
  • Access to treatment for injecting drug users
  • How long to treat genotype 2 and 3
  • Retreatment: consensus interferon
  • Earlier access to experimental hepatitis C drugs
• HIV and Hepatitis C: Similarities and Differences
• Further Information
  • Web links and resources
  • HIV and hepatitis C organisations and websites
  • Medical conferences
  • Ask the experts and other online advice
  • Drug and alcohol support
• Glossary
• Lab Results Record Sheet
• Personal Accounts
  • Add your story
  • Personal stories in this guide
  • Contributors
    • Carmen, Spain
    • Mauro, Italy
    • Marianna, Poland
    • Silvia, Italy
    • Dean, UK
• Diagram: The Liver and Related Organs of the Body
• Web-Only Content List

Disclaimer
Information in this guide is not intended to replace information from your doctor or other healthcare workers. Decisions relating to your treatment should always be taken in consultation with your doctor.

Authors
This guide was written and compiled by Simon Collins (HIV i-Base) and Tracy Swan (Treatment Action Group, USA). Additional contributions and editorial comments are included from Sanjay Bhagani, Polly Clayden, Marc Ennals, Ramon Espacio, Loon Gangte, Charles Gore, Camilla Graham, Mauro Guarinieri, Marianna Iwulska, Robert James, Maxime Journiac, Svilen Konov, Luis Mendão, Silvia Petretti, David Pieper, Jack Summerside, Joan Tallada, Carmen Tarrades and Kate Thomson. Pictures by Beth Higgins and Simon Grindrod.

Additional thanks to the Hepatitis C Trust, UK for permission to use text from their website.

Information dates quickly. If you're reading after May 2008, please call in case an updated version is available. Not-for-profit copying is encouraged.

Funding for this guide was provided by The Monument Trust.

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