Concerns with HIV and Hepatitis C Coinfection?Hepatitis C (HCV) infection is difficult. HIV will change your life. Infection with HIV and HCV together makes the treatment of both much more difficult. HCV alone is a public health concern. Hepatitis C and HIV coinfection only makes the problem worse.
- About one quarter of all HIV positive people in the United States is also infected with HCV
- HCV is a major cause of chronic liver disease in the United States
- HCV infection progresses more rapidly to liver damage in HIV-infected persons
- HCV infection impacts the course and management of HIV infection.
The U.S. Public Health Service/Infectious Diseases Society of America (USPHS/IDSA) guidelines recommend that all HIV infected people should be screened for HCV infection. Prevention of HCV for those not already infected as well as reducing the damage of chronic liver disease in those who are infected are important concerns for HIV infected people and their health care providers.
Who is Likely to Be Co-Infected with HIV and HCV?HCV is transmitted primarily by prolonged or repeated exposures to contaminated blood; typically through the skin by way of a needle puncture. Therefore, co-infection with HIV and HCV is common among:
- HIV infected injection drug users(IDUs)
- among people with hemophilia who received blood products before 1987
HCV Infection Through Sexual Exposure or From Mother to ChildThe risk for acquiring infection through sexual exposures or from mother to child is much lower for HCV than it is for HIV. In fact for persons infected with HIV through sexual exposure (e.g., men who have sex with men), co-infection with HCV is no more common than among similarly aged adults in the general population.
What are the Effects of CoinfectionCoinfection with HIV and HCV can change the prognosis and disease progression of both.
- Chronic HCV infection develops in 75 to 85 percent of infected persons and leads to chronic liver disease in 70 percent of these chronically infected people.
- HIV and HCV co-infection has been associated with higher blood levels of HCV, more rapid progression to HCV-related liver disease, and an increased risk for HCV-related cirrhosis (scarring) of the liver.
- HCV infection has been viewed as an opportunistic infection in HIV infected people since 1999. It is not, however, considered an AIDS-defining illness.
- As HIV medications and prophylaxis of opportunistic infections increase the life span of persons living with HIV, HCV-related liver disease has become a major cause of hospital admissions and deaths among HIV-infected persons.
The effects of HCV co-infection on HIV disease progression are less certain. Some studies have suggested that infection with certain HCV genotypes is associated with more rapid progression to AIDS or death. However, the subject remains controversial. Since co-infected patients are living longer on HIV medications, more data are needed to determine if HCV infection influences the long-term natural history of HIV infection.
How Can Co-Infection with HCV Be Prevented?Persons living with HIV who are not already co-infected with HCV can adopt measures to prevent acquiring HCV. Such measures will also reduce the chance of transmitting their HIV infection to others. HCV prevention methods include:
- stopping injection drug use by employing substance abuse treatment and prevention programs.
- if patients continue to inject drugs, they should be counseled about safer injection practices such as using new, sterile syringes every time they inject drugs and never reusing or sharing syringes, needles, water, or drug preparation equipment ("works").
- Toothbrushes, razors, and other personal care items that might be contaminated with blood should not be shared.
- Although there is no data indicating that tattooing and body piercing place people at increased risk for HCV infection, these procedures may be a source for infection with any one of many blood borne illness if proper infection control practices are not followed.
- Although consistent data is lacking regarding the extent to which sexual activity contributes to HCV transmission, persons having multiple sex partners are at risk for other sexually transmitted diseases (STDs) as well as for transmitting HIV to others. Therefore, safer sex practices should be employed.