HIV and Hepatitis C
Hepatitis C is a liver infection caused by the hepatitis C virus (HCV).HCV is spread mainly through contact with the blood of a person who has HCV. Most people become infected with HCV by sharing needles or other equipment to inject drugs.
According to the Centers for Disease Control and Prevention (CDC), approximately 25% of people with HIV in the United States also have HCV. Infection with both HIV and HCV is called HIV/HCV coinfection.
People with both HIV and HCV may be treated for both infections. Health care providers prescribe HIV and HCV medicines carefully to avoid drug-drug interactions and closely monitor those taking the medicines for any side effects.
What is hepatitis?
Hepatitis means inflammation of the liver. When the liver is inflamed or damaged, its function can be affected. Heavy alcohol use, toxins, some medications, and certain medical conditions can all cause hepatitis. However, hepatitis is often caused by a virus. In the United States, the most common hepatitis viruses are hepatitis A virus, hepatitis B virus, and hepatitis C virus.
Hepatitis B Virus and Hepatitis C Virus Infection
People with HIV infection in the United States are often affected by chronic viral hepatitis; about one-third are coinfected with either hepatitis B virus (HBV) or hepatitis C virus (HCV). More people living with HIV are infected with HCV than with HBV. About 1 in 10 people living with HIV are coinfected with HBV, and about 1 in 4 people are coinfected with HCV.
Like HIV, HBV and HCV are spread by sharing needles, syringes, and other injection equipment. Both viruses can also be transmitted sexually, but HBV is much more likely than HCV to be transmitted sexually. Sexual transmission of HCV is most likely to happen among gay and bisexual men who are living with HIV. Pregnant women can pass these infections to their infants.
Viral hepatitis progresses faster and causes more liver-related health problems among people with HIV than among those who do not have HIV. Liver disease, much of which is related to HBV or HCV, is a major cause of non-AIDS related deaths among people living with HIV.
Everyone living with HIV should be tested for HBV and HCV. Those who are at risk for HBV should be vaccinated against it. Vaccination is the best way to protect against all of the ways that HBV is transmitted. No vaccine exists for HCV. The best way to prevent HCV infection is to never inject drugs or to stop injecting drugs by getting into and staying in drug treatment. If you continue injecting drugs, always use new, sterile needles or syringes, and never reuse or share needles or syringes, water, or other drug preparation equipment.
HIV-HBV and HIV-HCV coinfections can be effectively treated in most people, but treatment can be complex, and people with coinfection should look for health care providers with expertise in the management of both HIV infection and viral hepatitis. For HBV, treatment can delay or limit liver damage by suppressing the virus. Treatment for HCV infection cures more than 90% of people, including those living with HIV, in 12-24 weeks.
Hep C testing: how does it work?
You need two tests to know for sure if you have Hep C. Both are blood tests. The first test checks for Hep C antibodies in your blood (Hep C antibody test). Antibodies are like flags that tell you if the Hep C virus has ever been in your body. If the first test finds Hep C antibodies, you need to get a second test to see if Hep C is still in your body, since some people can clear the Hep C virus without treatment. The second test is called the RNA test or PCR (polymerase chain reaction) test; it will tell you if you have the active virus. If this test is positive you have Hep C. Hep C testing is confidential. Anonymous Hep C testing is not available in Canada.
How does HIV affect hepatitis C?
HIV increases the risk for—and can speed up the development of—liver damage from hepatitis C. Other factors, such as alcohol intake, duration of hepatitis C infection, hepatitis B coinfection, being older than 40 and using certain antiretrovirals (ARVs), such as Videx or Zerit), may also worsen liver damage. People with fewer than 200 CD4 cells are more likely to have liver damage from hep C.
People who are coinfected may need to select HIV meds carefully with their care providers. Although the benefits of HIV treatment outweigh the risks, many medications used to treat HIV, including the protease inhibitors and the non-nucleoside reverse transcriptase inhibitors, are broken down (metabolized) by the liver and can cause liver injury, even in people who aren’t living with HCV. People taking ARVs should have their liver enzymes monitored regularly.
On the one hand, these particular drugs may worsen or speed up the liver disease being caused by hepatitis C. On the other hand, many experts think that treating HIV can delay liver disease progression by keeping the immune system strong.
What is the risk of coinfection?
A coinfection is when someone has two or more infections at the same time. People living with HIV are at risk of developing coinfections such as hepatitis C because HIV weakens the immune system, which leaves the body more vulnerable to other infections and illnesses.
HIV and HCV are also transmitted in similar ways, which means that people who have HIV may be at higher risk of exposure to HCV. In the United States, over a third of people living with HIV also have hepatitis C.
Coinfection of HCV and HIV is higher among those who use injected drugs. According to the Centers for Disease Control and Prevention (CDC), HCV coinfection occurs in between 62 and 80 percent of people with HIV who use injected drugs.
A systematic review of 783 studies concluded that people living with HIV were six times more likely to have hepatitis C than people without HIV.
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