Coinfection with Hepatitis C and HIV
HIV and hepatitis C are completely different viruses. You can have both illnesses at the same time. When this happens it is called coinfection. According to the U.S. Centers for Disease Control and Prevention (CDC), approximately 25 percent of people with HIV also have hepatitis C. This number is much higher, between 50 and 90 percent, for injection drug users with HIV. Although it is possible to treat both conditions, having both does cause complications in treatment.
Symptoms of hepatitis C often are not visible for many years, until after you have liver damage. If you have HIV, it is important to have regular screenings for hepatitis C, especially prior to beginning antiretroviral therapy. This virus may not show up on blood tests for many months after contracting it, therefore, one test is often not enough. Based on your lifestyle, your doctor will discuss how often you should have screening tests for hepatitis C.
Treating One Can Worsen the Other
Medications used to treat hepatitis C, interferon and ribavirin, can compromise your immune system, worsening HIV symptoms. According to the CDC, using interferon alone does not cause serious problems, however, the combination therapy of both drugs can lead to severe complications and sometimes death in patients with HIV. Doctors are urged to use both medications with caution when treating someone with both hepatitis C and HIV. On the other hand, medications used for HIV can increase your risk of contracting hepatitis C and can damage your liver. If you are being treated for HIV and also need treatment for hepatitis C, your doctor will discuss the need to stop any medications that suppress your immune system.
Interferon also presents another problem for injecting drug users who have stopped. The effects resemble drug withdrawal and because of this, can create an urge to inject again, creating a higher risk of hepatitis C reinfection.
HIV lowers your immunity and ability to fight off infections. This means that not only do you have a higher chance of contracting hepatitis C, you have a higher risk of developing cirrhosis and liver cancer. In the 1990s, new drugs, called highly active antiretroviral therapy (HAART) were introduced for patients with HIV. The success of these medications meant that HIV patients lived longer. Because hepatitis C can take up to 30 years to progress to severe liver damage, previous to HAART, those with HIV and hepatitis C did not normally live to the point of liver failure. Now, HIV patients are living longer and feeling the effects of hepatitis C. Liver damage also occurs quicker in those with HIV; individuals with HIV are three times more likely to develop cirrhosis. According to one recent study, end-stage liver disease was the leading cause of almost one-half of the HIV-infected patients in the study. According the the U.S. Department of Veteran's Affairs, hepatitis C is the leading cause of death in people with HIV.
The Good News
While difficult, treatment for individuals who have both hepatitis C and HIV can and is successful. The antiretroviral medications used to treat HIV can slow down the progression of liver disease and restore function to your body's immune system. The benefits of this type of therapy usually outweigh the risks associated with it.
"Coinfection with Hepatitis C Virus and Human Immunodeficiency Virus: Virological, Immunological, and Clinical Outcomes," 2009, Aug, Yaron Rotman and T. Jake Liang, Journal of Virology
"Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents," Updated 2012, March 27, Staff Writer, AIDSinfo.nih.gov
"Hepatitis C and HIV Coinfection," 2012, Feb., Staff Writer, University of California, San Francisco
"Hepatitis C Virus and HIV Coinfection," 2002, September, Staff Writer, U.S. Centers for Disease Control and Prevention