Title - The AIDS InfoNet

InfoNet Logo

New Mexico AIDS InfoNet

Fact Sheet Number 506

HEPATITIS C AND HIV

WHAT IS HEPATITIS C?
HOW IS IT DIAGNOSED?
HOW IS HEPATITIS C TREATED?
CAN HEP C BE PREVENTED?
HEP C AND HIV TOGETHER
THE BOTTOM LINE

this Fact Sheet on a single page using:

Microsoft Word

Adobe Acrobat

More information on Downloading

& Printing Fact Sheets

WHAT IS HEPATITIS

Hepatitis C is a liver disease caused by a virus. The hepatitis

C virus (HCV) is transmitted through infected blood. Sexual activity

can expose you to infected blood. Hep C spreads easily when drug

users share equipment.

Infected blood spreads hepatitis C more easily than HIV. In

the US, about 4 times as many people have Hep C as have HIV. You

could be infected with HCV and not know it. About 15% of people

clear the Hep C virus from their bodies without treatment. The

other 85% develop chronic infection, and the virus stays in their

body unless it is successfully treated.

Hep C might not cause any problems for about 10 years or even

much longer, but it can cause serious liver damage leading to

liver failure and death.

HOW IS IT DIAGNOSED?

When Hep C damages the liver, a blood test will show abnormal

results for liver function tests. See Fact

Sheet 107 for more information on these tests. High levels

of the liver enzymes alanine transaminase (ALT) and alkaline phosphatase

(ALP) can be signs of liver disease or damage.

Even if you have normal liver tests, Hep C could be starting

to damage your liver. If you have HIV, it’s a good idea to get

tested for Hep C. This is especially true if you ever shared equipment

for using drugs.

Blood tests for Hep C infection and HIV

infection are similar. They look for signs that your immune

system is fighting Hep C (antibodies), or they look for the Hep

C virus (a Hep C viral load test.) Fact

Sheet 413 has more information on HIV

viral load tests. Hep C viral loads can often be in the millions.

They don’t predict disease progression the way HIV viral loads

do.

Liver tests can be normal even though Hep C is damaging the

liver, so some doctors do a test called a biopsy. Using a thin

needle, the doctor gets a small sample of liver cells. They are

studied using a microscope. A biopsy shows how much Hep C has

already damaged your liver.

HOW IS HEP C TREATED?

Almost all cases of hepatitis C could be cured if treatment with

interferon starts very soon after infection. Unfortunately, early

signs of hepatitis can seem like the flu. Most cases are not diagnosed

until years after infection.

The first step in treating Hep C is to find out which strain

of Hep C you have. There are six known varieties of Hep C, called

“genotypes.” Most people with Hep C in the US have genotype

1. Some people have genotype 2 or 3. Genotype 1 is harder to treat

than genotypes 2 or 3.

The usual treatment for Hep C has been a combination of the

drugs interferon and ribavirin. Interferon has to be injected

under the skin three times a week, and ribavirin is a pill taken

twice a day. These drugs have some serious side effects, including

flu-like symptoms, irritability, depression, and low counts of

red blood cells (anemia) or white blood cells.

Ribavirin increases the amount of ddI in your blood. If you

are taking both drugs, you should watch carefully for signs of

ddI side effects. Ribavirin can cause severe birth defects.

Women should not use it for at least six months before they

become pregnant, or during pregnancy. Men should not use ribavirin

for at least six months before they get a woman pregnant.

A new form of interferon called “pegylated interferon”

was approved for treating Hep C in 2001. Pegylated interferon

stays in the blood longer. Only one injection is needed each week.

Pegylated interferon seems to be stronger than the original form.

It is also used in combination with ribavirin.

HCV treatment usually lasts 6 or 12 months, depending on which

Hep C genotype you have. After treatment, about 40% of patients

have an undetectable Hep C viral load. This means that the amount

of HCV in their blood is too low for the test to detect.

People who still have detectable HCV after treatment may need

to continue using interferon at lower doses. This is called “maintenance

therapy.”

Several factors affect how well Hep C treatments work. People

do better if they:

Have type 2 or 3 Hep C
Start with a lower Hep C viral load
Start before Hep C damages the liver
Are women
Are younger than age 40
Do not drink alcohol

CAN HEP C BE PREVENTED?

Although there are vaccines to protect you from getting infected

with Hep A or Hep B, there is no vaccine yet for Hep C. The best

way to prevent Hep C infection is to avoid being exposed to blood

that is infected with Hep C. If you don’t share equipment to use

drugs and avoid other contact with the blood of people infected

with Hep C, your risk of Hep C infection will be lower.

HEP C AND HIV

TOGETHER

Because HIV and Hep C are both spread by contact with infected

blood, many people are infected by both viruses. This is called

coinfection. There are some extra things to think about for people

who are coinfected with HIV and Hep C. However, Hep C doesn’t

make HIV disease any worse and doesn’t interfere with anti-HIV

medications.

For people with HIV, Hep C can be more serious and can cause
liver damage more quickly.
People with HIV are more likely to transmit Hep C to others
because their Hep C viral loads are higher.
The drugs used to treat HIV are hard on the liver. However,
we don’t know if HIV medications make Hep C worse.
If someone meets the guidelines to treat HIV, and they have
a mild case of Hep C, their HIV should be treated first. Leaving

advanced HIV untreated for 6 to 12 months could have serious

consequences.
However, if HIV doesn’t need to be treated yet (if T-cell
counts are high enough, and HIV viral load is low enough), it’s

a good idea to treat Hep C first. Then the liver can be in better

condition to deal with HIV drugs.