Treatment of Hepatitis C if You Have HIV/AIDS
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Hepatitis C is a disease of the liver caused by the hepatitis C virus (HCV). Over time, HCV can cause serious liver damage including cirrhosis (scarring), liver cancer, and life-threatening liver failure.
Because both HIV and HCV can be spread by contact with infected blood, many people are infected with both viruses. This is called co-infection. About one in four people living with HIV (HIV+) in the US are co-infected with HCV. Co-infection is even more common among HIV+ injection drug users, of whom about 80 percent also have HCV.
HCV can progress more rapidly and lead to serious liver damage more often in HIV+ people. According to the Centers for Disease Control and Prevention (CDC), having HIV more than triples the risk of liver disease, liver failure, and liver-related death due to HCV. Co-infection with HCV may also make HIV treatment more challenging. Therefore, it is important for HIV+ people to know whether they have HCV. The CDC recommends that all HIV+ people be screened for both hepatitis B and hepatitis C. Some experts recommend that HIV+ people at risk for HCV be screened every year.
Treatment of HIV/HCV co-infection is complicated. It is important to have a health care provider who is familiar with HIV and HCV to get the best treatment for both diseases. The good news is that HCV can be treated successfully, even in HIV+ people.
There are many things to consider when deciding if and when to begin treatment for HCV. Talk to your health care provider about all your options before deciding. If you are at risk for HCV disease progression and liver damage, you may want to consider starting HCV treatment sooner rather than later since research shows that earlier treatment has a better outcome.
Not everyone who has HCV needs treatment. Among those who develop chronic HCV, many will not develop serious liver damage. Research shows, however, that HIV+ people are more likely to develop HCV-related liver damage and develop it faster than HIV-negative people.
Health care providers look at a variety of tests and health-related factors when deciding whether or not to recommend HCV treatment. Treatment decisions are not based on symptoms alone, since the early stages of liver damage do not always cause symptoms or abnormal lab test results. Instead, health care providers consider any symptoms, your overall health, the results of liver enzyme tests, and the results of tests that determine the extent of any liver damage.
Tests for HCV include:
In general, health care providers are more likely to suggest treatment if you:
There are also several factors to consider that have been shown to be associated with faster disease progression in HCV-infected people. Some of these factors include:
Treatment options for HCV have improved a great deal in recent years. Today, the standard treatment is a combination of two medications:
The length of HCV treatment depends on the type of HCV a person has and whether they are co-infected with HIV. There are several different types of HCV, called genotypes. Genotypes 2 and 3 are easier to treat and treatment usually lasts six months for HIV-negative people. Genotype 1 -- the most common in the US -- is harder to treat, so treatment usually lasts 12 months for HIV-negative people. One year of HCV treatment is recommended for people with both HIV and HCV.
Last year, the US Food and Drug Administration (FDA) approved two new drugs for hepatitis C treatment: Victrelis (boceprevir) and Incivek (telaprevir.) Both drugs are HCV protease inhibitors; they work by interrupting HCV’s ability to multiply or replicate. They are both meant to be taken in addition to the standard treatment combination of pegylated interferon plus ribavirin. Recent studies have shown that people who took either Victrelis or Incivek in addition to pegylated interferon and ribavirin had higher cure rates than those taking pegylated interferon and ribavirin alone. Studies directly comparing Victrelis to Incivek have not yet been done.
This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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