Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) Co-Infection
Major efforts have been underway in the detection and treatment of HIV over the past two decades. Hepatitis C Virus (HCV) was detected in 1989 and now there is evidence of twin epidemics emerging in the U.S. including HIV/HCV co-infected individuals. About 350,000 Americans are estimated to be co-infected. The risk factors for acquiring HCV are similar to those for HIV and include:
- transfusion prior to 1991;
- injecting drug use;
- tattooing or body piercing;
- long term hemodialysis;
- high risk sexual contact (multiple partners over time);
- occupational exposures to blood or blood products (health care workers);
- receiving an organ or tissue transplant from someone infected with HCV; and
- birth to an HCV-infected mother.
The most common route for transmission is injecting drug use. Although sexual transmission is low for HCV, it is increased when there is concurrent HIV infection. Co-infected women are three to four times more likely to transmit HCV to their unborn children than women with HCV only. Transmission of HCV from breast feeding has not been definitively demonstrated.
In co-infected persons, HCV infection progresses faster than if infected with HCV alone. The hepatitis C virus will multiply faster in HIV infected persons. However, HCV does not increase the rate of multiplication of HIV.
Progression of liver disease is accelerated among co-infected individuals, especially those with compromised immune systems from HIV infection. In co-infected persons, age at time of HCV infection, immune cell (CD4) count and level of alcohol consumption are associated with a higher rate of liver fibrosis. Without successful treatment for HCV, co-infection usually leads to an earlier death. At present, liver disease accounts for 50% of deaths among those with HIV.
The strategies for treatment include: eliminate HCV or convert it to an "inactive" state; slow disease progression; reduce the risk for developing cancer; and, use medications that don't interfere with HIV medications. Treatment approaches may include single-drug therapy (referred to as monotherapy) or combination therapy. Combination therapy has a higher percentage of eradication (killing the virus for good) than monotherapy, but the side effects are more evident with combination therapies. Treatment approaches are complicated for women who are pregnant. Lifestyle changes (such as sobriety, nutrition, stress management, exercise), alternative or complementary therapies (acupuncture and herbs) and vaccinations against hepatitis A and B are also considered.