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Hepatitis C + HIV Co-infection

Around 13% [1] of people living with HIV in Australia are co-infected with hepatitis C.

[1] (HIV Futures Five, La Trobe University, pp7, 2006)

How does HIV affect hepatitis C?

There is significant evidence that indicates HIV makes hepatitis C worse. Hepatitis C is more severe in people with HIV and may progress more rapidly to liver disease. This seems to be the case even if you have a high CD4 count. More severe liver damage is seen in people with advanced HIV disease.

The reasons for this are not completely known. You should discuss this issue carefully with your doctor or an infectious disease specialist.

For a small group of co-infected people, when they first begin HIV treatment, they may experience a flare up of hepatitis C symptoms and feel quite sick. This can be a sign that the body is rebuilding the immune system. It is usually a short-term problem and tends to resolve as the treatment begins to work and the immune system stabilises. Discuss this issue with your doctor.

How does hepatitis C affect HIV?

There is still debate about whether hepatitis C affects HIV. Some studies have suggested that infection with hepatitis C can lead to more rapid progression of HIV, but others have not. Hepatitis C does damage the liver, which can make it harder to take HIV medication.

Treating hepatitis C for people with HIV

Although more complicated than treating hepatitis C alone, people with HIV can be treated for hepatitis C. The aim of treatment is to clear the virus completely from the body. If clearance is not possible, then the treatment will aim to normalise liver function and prevent further damage to the liver.

There has been a significant improvement in treatment for hepatitis C in recent years. The usual treatment is a combination of the drugs peg-interferon and ribavirin. Peg-interferon has to be injected under the skin weekly and ribavirin is a pill taken twice a day. The drugs can have severe side effects, although they tend to lessen as treatment goes on.

Possible side effects include: high temperatures, flu-like symptoms, joint pain, weight loss, irritability, feeling sick and depression. Depression is particularly common in people taking pegylated interferon and antidepressants may be offered if you are taking this drug. The other major side effect is blood abnormalities including anaemia (low red blood cell count) caused by ribavirin.

The success of treatment depends upon the genotype (genetic types or strains of the hepatitis C virus). Genotypes two and three respond better to treatment (50% success rate) than genotypes one and four (25% success rate).

Treatment of early hepatitis C infection (less than six months) has achieved higher success rates. Talk with your doctor.

How does hepatitis C affect HIV treatment?

HIV can be treated if you also have hepatitis C. It is important to keep an eye on your CD4 count and HIV viral load and to be additionally careful about taking medication and getting regular check-ups. Hepatitis C can affect HIV treatment choices, because some drugs used to treat HIV are also hard on the liver. You need to carefully plan treatment combinations with your doctor. They will regularly check how your liver is coping to make sure the HIV drugs are not causing any problems.

Hepatitis C and HIV co-infection can slow down the rate of increase in CD4 cell counts during treatment, because the body is dealing with two viral infections at the same time.

Which to treat first - HIV or hepatitis C?

It is currently recommended that the infection posing the greatest threat to health be treated first. If you have a good CD4 cell count and are not becoming ill because of HIV, you may be offered the choice of receiving treatment for hepatitis C before you start HIV treatment. However, if your CD4 cell count is low, falling rapidly, or you are becoming ill because of HIV, then you might be recommended to start HIV therapy first.

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