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Hepatitis C and HIV co-infection - Double trouble

Fri 2 Sep 2005 In: HIV

Hepatitis C (HepC or HCV) and HIV (the virus that causes AIDS) are two different viruses which share some common characteristics. What happens when a person is infected with both viruses (co-infection) at once? Eamonn Smythe, National Positive Health Manager for the New Zealand AIDS Foundation explores this issue. Hepatitis, unlike HIV, is a non-sexually transmitted disease that is curable in many cases and does not get into the body's genetic structure. HIV is an incurable but, with good and early treatment, manageable long term viral infection. However, like HIV, HepC can be transmitted through blood-to-blood contact; is a virus that replicates rapidly; and is, if left untreated, potentially fatal as it can cause serious liver damage. In patients who acquire HIV infection sexually, HCV co-infection is rare, but the presence of both viruses is much more frequent when the means of transmission has been the shared use of drug injecting equipment. While clinical studies provide differing results, with research literature divided on whether HCV accelerates the progression of HIV, there is clear data that shows that HIV accelerates the progression of liver damage (fibrosis) in those with co-infection as one of the main toxic effects of anti-retroviral-treatment (ART) is on the liver. The increased use of effective antiretroviral medication for HIV treatment has greatly reduced the impact of complications from opportunistic diseases attacking the body after HIV has suppressed the immune system. Liver disease caused by chronic hepatitis C virus infection is now a leading cause of serious illness and death among HIV-infected patients in the developed world. At the recent conference in Rio on the progression of HIV illness, an interview was held with Dr Greiger about HIV/Hepatitis co-infections concerning special treatment issues in patients with liver disease. In this she addresses one of the primary questions: “Should I treat the hepatitis C first or treat the HIV first?” She states: Ideally you should treat the hepatitis C first but "ideally" is not in the everyday world. So if you can, yes -- you treat the HCV first and then you treat the HIV, but in most cases I do treat both at the same time. If the patient is at a stage where treatment is needed, HAART (a regime of HIV medications) should not be postponed. According to The Johns Hopkins University, which was the first research university in the United States, infectious diseases- patients with well controlled HIV (that is with an undetectable viral load and a healthy level of immune system cells) should be considered for treatment for their HepC infection because of their long life expectancy from well-managed HIV. However, it is important to remember that when dealing with co-infection there are no perfect patients. All treatment decisions must be made on an individual basis in consultation with the Infectious Disease medical team. Treatment decisions will be based on a number of factors, not just the CD4 (immune cell) count, but also a larger more comprehensive health review. On a final point, while Hepatitis C is not recognised as a sexually transmitted disease, there is never-the-less a (small) risk of transmission during sex. While HepC has been found in some sexual fluids, the risk lies not so much in the exchange of body fluids but in the passage of blood within them. If there is blood in sexual fluids, (even if it can't be seen) this poses a risk of transmission, if your partner has a break in the skin through which the fluid can pass into their blood stream. The HepC virus is present in menstrual blood and therefore vaginal sex should be avoided during this time, and using condoms when having anal sex is also recommended (for men-who-have-sex-with-men or heterosexuals). In order to avoid condom breakage, skin damage or abrasion during sex, a water or silicone based lubricant should be used, as oil based lubricants (such a Vaseline) can damage condoms. NZAF - 2nd September 2005    

Credit: NZAF

First published: Friday, 2nd September 2005 - 12:00pm

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