September Newsletter

Co-infection with Hepatitis C and HIV

When a person has both human immune deficiency virus (HIV) and hepatitis C (HCV), it's referred to as "co-infection". The precise number of co-infected people in Colorado is yet to be determined. Studies estimate that of all people infected with HIV, approximately 30% are also infected with HCV.

HIV is transmitted through several bodily fluids that include vaginal fluid, semen and blood, whereas HCV is only transmitted through blood. HCV is more easily transmissible than HIV. The HCV virus can live for a long time, up to several weeks, outside the human body on inanimate object compared to HIV, which only lives outside the human body for a matter of seconds.

Risk factors for acquiring HCV can be similar to HIV. People who in the past or currently use intravenous drugs or "snorted" are at a higher risk of acquiring HCV. Blood that remains in or outside needles, water, cotton, or other "works" can transmit HCV. Other risk factors include receiving home-made tattoos or body piercings, manicures and pedicures with unsterilized equipment and/ or ink. Healthcare workers can be at increased risk due to potential occupational exposure, or exposure to blood while working. Persons that have received blood or tissue products prior 1992 are at risk and should also be screened for HCV. Early detection means better treatment options and health outcomes. Thus, screening for HCV should be considered when an individual is known to have HIV, and vice versa.

Screening for HIV or HCV antibodies consists of collecting a small blood sample and answering a few questions from a health counselor. Screening is confidential and free. It usually takes 1 to 2 weeks to receive your results. The initial test for either HIV or HCV is only to screen for antibodies. The initial test should be done 3 to 6 months from risk. For any test that comes back positive, a second test to confirm is done. Your provider will answer any questions and walk you through "next steps".

Hepatitis C damages the liver. The liver is an essential organ that filters waste, bacteria and poisons from your blood and also stores vitamins and sugars that your body uses for energy. A healthy liver is smooth and firm to touch. If there is progressive liver damage the presence of fibrosis exist, which is small scaring. Liver damage can also include some shrinking and hardening and formation of nodules. If cirrhosis exist, the liver may become small and hard, with extensive scarring and many nodules. The ability for the liver to function appropriately is compromised when an individual has one or both of these conditions. In these situations, the liver is not able to filter waste, toxins, and drugs from the blood. It can no longer produce the clotting factors necessary to stop bleeding. Fluid builds up in the abdomen and legs, bleeding in the intestines is common, and eventually mental functioning is slowed. At this point, a liver transplant is the only option. Liver transplantation is a drastic last resort, occurring in about 4% of persons who only have HCV. Persons who are co-infected have a lower priority to receive a liver.

Approximately 80 to 85% of persons, who only have HCV, can carry it chronically 30 years or longer. "Chronic" carriers usually have no symptoms because of the livers ability to hide damage and the fact that the liver continues to grow fresh tissue, therefore, maintaining its basic functions. Every person's situation is unique because of individual lifestyle choices.

Co-infection affects the impact of disease progression. The rate of hepatitis C disease progression appears to be more rapid in HIV-infected individuals compared to persons who only have HCV. It is not yet clear exactly how much more quickly acceleration occurs, but several studies have found that progression could be as much as 2-5 times faster. The longer a person has had both HIV and HCV, the more likely it is that HCV has progressed.

Luckily, both HIV and HCV have treatment options available. In HIV, response to treatment may be better if treatment is started early. However, early treatment also has its downsides. HIV treatment may be life long. People who seek treatment may suffer from side effects associated from HIV medications, as well as follow often complicated treatment schedules or regimens. HCV treatment may be more successful if also started earlier. Treatment for HCV typically lasts 6 to 12 months, often with significant side effects. Persons who are co-infected should work closely with their providers to weigh options and individual situations.

Whether a person is co-infected or only has HCV, many will seek alternative management options to improve overall health. These can include herbal treatment, emotional support, a fitness program, yoga or specific diet choices, etc. There are many options to adopt in ones life to achieve a balance of wellness and good health. Again, individual choices should be considered that are practical and realistic.

Hep C Connection offers information, national resources and free support groups across Colorado that can help those who are infected or for loved ones who are challenged by HIV and/ or HCV.

For more information, hepatitis C testing, or support, please call our HelpLine at 800-522-HEPC (4372) to speak to a caring and knowledgeable counselor.

Artical written by Stewart Thomas, Medical and Marketing Liaison