Simple FactSheet: HCV and HIV Co-infection

HCV and HIV Co-infection
a Simple FactSheet from the AIDS Treatment Data Network

||||| What does Co-infection mean?

The relationship between HIV and HCV is a complicated one. Researchers are just beginning to understand how coinfection with these two viruses affects the body. The hepatitis C virus (HCV) was identified in 1988 as one of the leading causes of serious liver disease. HCV testing is recommended for anyone who is HIV positive. About 33% of all people with HIV also have HCV. New Public Health Services guidelines have included HCV as an opportunistic infection associated with HIV infection. New combination therapy treatments were recently approved by the FDA to treat Hepatitis C. These treatments do not work on everyone. They can often caused serious side effects. A person's race, gender, age, the type of HCV, and how long they've been infected can all affect how well these treatments will work. As people with HIV live longer through the use of anti-HIV drugs, End Stage Liver Disease (ESLD) in HCV coinfected people has become the leading cause of death, accounting for almost 50% in recent studies. The fact that even people with high CD4 counts can still die from liver disease, points out the importance of understanding and treating both HCV and HIV.

||||| Hepatitis C appears to progress more quickly in people with HIV

Hepatitis C disease usually develops very slowly. People may live with HCV for 10 to 30 years before they start to feel sick. In HIV coinfected people, HCV disease may develop much quicker. The symptoms are more severe, leading to serious liver disease. Studies have shown that HCV multiplies up to 8 times faster in people coinfected with HIV.

||||| Keeping HIV under control may help to stop or slow HCV disease progression

The exact way HCV causes hepatitis (inflammation or swelling of the liver) is not known. There are several possible ways being studied. Both HIV and HCV can infect liver cells and reproduce in them, directly causing damage to these cells. The body's immune system can attack these infected liver cells, killing not just the viruses hiding within but also the liver cells themselves. The resulting inflammation can cause scarring and damage the veins that flow through the liver to other organs. Studies have shown that low HIV levels in the blood can help to slow down HCV disease.

||||| Keeping the liver healthy increases people's ability to tolerate HIV medication

Most anti-HIV drugs are tough on the liver. Long term side effects such as fatigue, wasting, lypodistrophy (irregular fat distribution), diabetes (high blood sugar), high cholesterol and high blood pressure are not uncommon. Levels of nutrients and chemicals in the blood, such as fat, sugar, cholesterol, lactate , protein and hormones can become too high or too low in people taking anti-HIV drugs. Since the liver is the organ that processes, produces, and/or regulates these basic elements in the blood, other major organs in the body can be affected, including the heart, eyes, pancreas, and gall bladder. It is very important to choose HIV drugs that are least likely to harm your liver, and to closely monitor your liver while on HIV drugs.

||||| Current Hepatitis C treatments may be less effective in people with advanced HIV

Studies are still underway to understand how well HCV treatment works in people coinfected with HIV. Early results based on small groups of patients show that HCV treatment is less effective if the person's HIV viral load is greater than 2,000,000 or if they have less than 200 CD4. HCV treatment is not recommended in co-infected people if they have less than 200 CD4 cells, but some suggest that the cutoff point could be either 150 or 100 CD4. In addition, interactions between the combinations of drugs taken for HIV and HCV are complicated. Both therapies include medications that can cause anemia (low red blood cells). HCV treatment can lower CD4 cells and be harmful to the immune system. HCV treatment may also change the amount of anti-HIV drugs in the blood, potentially causing resistance to these drugs. The risk of developing side effects from HIV drugs, especially Videx (ddI, didanosine) and Retrovir (AZT, azidothymidine) is greater in people taking HCV medications. Due to these concerns, liver and HIV doctors often prefer to treat HCV first, when someone has well above 500 CD4 cells.

||||| HIV treatment specialists may not be experienced in HCV treatment

Since hepatitis C treatments are very new, it is very important to work with a doctor who is experienced at treating liver problems. Blood tests to measure liver function, viral load tests for both HIV and HCV, and liver biopsy reports all need a trained specialist to interpret. Side effects of these new treatments are very common. You need a doctor able to recognized and identify the symptoms of these side effects. If your doctor decides to refer you to a liver specialist, he or she will probably refer you to a hepatologist or a gastroenterologist. If you need a referral to a liver specialist, or have other questions about HIV/HCV co-infection click Request Information

AIDS Treatment Data Network • The Access Project
Last modified: 03/24/2009
The Network

\|\|\|\|\| What does Co-infection mean?
The relationship between HIV and HCV is a complicated one. Researchers are just beginning to understand how coinfection with these two viruses affects the body. The hepatitis C virus (HCV) was identified in 1988 as one of the leading causes of serious liver disease. HCV testing is recommended for anyone who is HIV positive. About 33% of all people with HIV also have HCV. New Public Health Services guidelines have included HCV as an opportunistic infection associated with HIV infection. New combination therapy treatments were recently approved by the FDA to treat Hepatitis C. These treatments do not work on everyone. They can often caused serious side effects. A person's race, gender, age, the type of HCV, and how long they've been infected can all affect how well these treatments will work. As people with HIV live longer through the use of anti-HIV drugs, End Stage Liver Disease (ESLD) in HCV coinfected people has become the leading cause of death, accounting for almost 50% in recent studies. The fact that even people with high CD4 counts can still die from liver disease, points out the importance of understanding and treating both HCV and HIV.
\|\|\|\|\| Hepatitis C appears to progress more quickly in people with HIV
Hepatitis C disease usually develops very slowly. People may live with HCV for 10 to 30 years before they start to feel sick. In HIV coinfected people, HCV disease may develop much quicker. The symptoms are more severe, leading to serious liver disease. Studies have shown that HCV multiplies up to 8 times faster in people coinfected with HIV.
\|\|\|\|\| Keeping HIV under control may help to stop or slow HCV disease progression
The exact way HCV causes hepatitis (inflammation or swelling of the liver) is not known. There are several possible ways being studied. Both HIV and HCV can infect liver cells and reproduce in them, directly causing damage to these cells. The body's immune system can attack these infected liver cells, killing not just the viruses hiding within but also the liver cells themselves. The resulting inflammation can cause scarring and damage the veins that flow through the liver to other organs. Studies have shown that low HIV levels in the blood can help to slow down HCV disease.
\|\|\|\|\| Keeping the liver healthy increases people's ability to tolerate HIV medication
Most anti-HIV drugs are tough on the liver. Long term side effects such as fatigue, wasting, lypodistrophy (irregular fat distribution), diabetes (high blood sugar), high cholesterol and high blood pressure are not uncommon. Levels of nutrients and chemicals in the blood, such as fat, sugar, cholesterol, lactate , protein and hormones can become too high or too low in people taking anti-HIV drugs. Since the liver is the organ that processes, produces, and/or regulates these basic elements in the blood, other major organs in the body can be affected, including the heart, eyes, pancreas, and gall bladder. It is very important to choose HIV drugs that are least likely to harm your liver, and to closely monitor your liver while on HIV drugs.
\|\|\|\|\| Current Hepatitis C treatments may be less effective in people with advanced HIV
Studies are still underway to understand how well HCV treatment works in people coinfected with HIV. Early results based on small groups of patients show that HCV treatment is less effective if the person's HIV viral load is greater than 2,000,000 or if they have less than 200 CD4. HCV treatment is not recommended in co-infected people if they have less than 200 CD4 cells, but some suggest that the cutoff point could be either 150 or 100 CD4. In addition, interactions between the combinations of drugs taken for HIV and HCV are complicated. Both therapies include medications that can cause anemia (low red blood cells). HCV treatment can lower CD4 cells and be harmful to the immune system. HCV treatment may also change the amount of anti-HIV drugs in the blood, potentially causing resistance to these drugs. The risk of developing side effects from HIV drugs, especially Videx (ddI, didanosine) and Retrovir (AZT, azidothymidine) is greater in people taking HCV medications. Due to these concerns, liver and HIV doctors often prefer to treat HCV first, when someone has well above 500 CD4 cells.
\|\|\|\|\| HIV treatment specialists may not be experienced in HCV treatment
Since hepatitis C treatments are very new, it is very important to work with a doctor who is experienced at treating liver problems. Blood tests to measure liver function, viral load tests for both HIV and HCV, and liver biopsy reports all need a trained specialist to interpret. Side effects of these new treatments are very common. You need a doctor able to recognized and identify the symptoms of these side effects. If your doctor decides to refer you to a liver specialist, he or she will probably refer you to a hepatologist or a gastroenterologist. If you need a referral to a liver specialist, or have other questions about HIV/HCV co-infection click Request Information