HIV coinfection with hepatitis c

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

HIV has been an important and familiar health and social crisis for two decades. Less familiar, but also important, is HCV infection. In HIV–HCV co-infected patients, the Hepatitis C (HCV) viral load is higher than in HCV-mono-infected patients in both the plasma and liver tissue.

Similarity between Hepatitis C with HIV: These two viruses are similar in a number of ways, and infection with both is a serious problem. Both HCV and HIV are transmitted by exposure to infected blood. About one-quarter of the people infected with HIV also have HCV.

The primary objective of HCV therapy is permanent eradication of the virus. The secondary potential benefit of eradication is a reduction in the risk of liver failure and liver cancer.

The introduction in the mid-1990s of highly active antiretroviral therapy (HAART) for HIV has caused a sharp drop in the number of deaths from AIDS. This means that people with HIV are living longer. Therefore, if they are co-infected, the complications from HCV have more time to develop. These complications (cirrhosis, liver cancer, end-stage liver disease) generally develop over 20-30 years.

Liver disease from HCV is now the leading non-AIDS cause of death in the U.S. in co-infected individuals with HIV. Treatment for each disease is complicated, expensive, and has side effects. This poses difficult issues for patients who are living with both HIV and HCV. Finally, co-infection is important because it has a disproportionate impact on certain communities, including those in prison and jail and communities of color.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

HIV’s effect on Hepatitis C: Studies have shown that HIV infection in a person who is also infected with HCV results in higher levels of HCV in the blood, more rapid progression to HCV-related liver disease, and increased risk for cirrhosis and liver cancer. As a result, HCV is now regarded as an opportunistic infection in people with HIV infection, although it is not considered an AIDS-defining illness.

HCV’s effect on HIV: Some research suggests that infection with genotype 1 HCV is associated with more rapid progression to AIDS or death, although this is still controversial. Most people with HCV infection in the U.S. have genotype 1. Genotypes 2 and 3 are more common in Europe. Some evidence also indicates that HCV is associated with impaired CD4+ T cell recovery during antiretroviral therapy.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Patients who are HIV-positive are commonly co-infected with HCV due to the following:

• Shared routes of transmission.
• Percutaneous exposure to blood.
• Sexual intercourse.
• From a mother to her infant.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

The majority of coinfected people are injection drug user (IDUs). HCV is acquired relatively soon after individuals begin injecting drugs. Within 5 years of beginning to inject, 50% to 80% of IDUs are infected with HCV. As a result, many IDUs who become infected with HIV are already infected with HCV. It is estimated that 50% to 90% of IDUs with HIV also have HCV .

Between 1996 and 2000, more than 80% of the patients admitted to a large HIV/AIDS care center in Madrid, Spain, were IDUs. The proportion of these patients who were admitted because of liver failure almost doubled, from 9% to 16%.

About one-third of people with HIV are coinfected with hepatitis B virus (HBV) or hepatitis C virus (HCV), with a considerably higher prevalence among injection-drug users.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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The effect of HCV on the natural history of HIV remains inconclusive due to contradictory studies documenting no effect, while others show an increase to an AIDS defining illness or death. The morbidity and mortality caused by HCV has increased since the inception of highly active antiretroviral therapy (HAART) because HIV patients are living longer from potent antiretroviral therapies and prophylaxis of traditional opportunistic infections. Infection with HCV can be asymptomatic, self-limiting, or progress to cirrhosis or cancer.

Over years or decades chronic hepatitis B and C can progress to serious liver disease including cirrhosis and liver cancer. HIV positive people with HBV or HCV tend to experience more rapid disease progression and do not respond as well to hepatitis treatment. End-stage liver disease is now the cause of death for 45% of HIV-infected patients in this hospital. HCV infection was the cause of the liver disease in nearly three-quarters of the HIV patients who were admitted or died during the course of the study.^[1]