POSITIVELY AWARE NOVEMBER/DECEMBER 2010
Ask the HIV Specialist
by Albert Malek, MD, AAHIVS
Question: I am a 35-year-old male who has been HIV-positive for the last 11 years. I have been compliant with my medications for the last 5-6 years. Currently, I am doing well on a combination of Combivir twice daily, Reyataz 300 mg plus Norvir 100 mg once daily and my viral counts have been undetectable for most of the last five years.
About six months ago, I was told that I also have hepatitis C, which I have not sought treatment for since I moved out of the area. I am quite concerned about my hepatitis C and am planning to start with a new HIV doctor in my area. What should I do for it when I see the new doctor?
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Answer: First, I would like to assure you that there are so many things that can be done to make a big positive difference in your situation. To start, you have to know that it is quite common for HIV patients to also have hepatitis C (an average of one in every five patients with HIV has hepatitis C). This is due to the fact that both diseases get transmitted in the same way, i.e. through blood and body fluid exchange between an infected and an uninfected person. The most common means of transmission are risky behaviors that may include sharing needles during drug use, unprotected multiple sexual partners, high risk sexual practices, and tattoos from unlicensed/unsupervised personnel. Sometimes, transmission can also happen after bloody fights or from accidental needle sticks in the medical field.
The new physician will probably need to find out the type of hepatitis C you have, which is done with a blood test called “hepatitis C genotype.” Different types of virus respond differently to treatment. Also, depending on the type of virus you have, you may need to have a liver biopsy to estimate the degree of the liver inflammation and scarring prior to treatment. The decision about if and when to start treating your hepatitis C will depend on many factors, including your physician’s experience, your overall health, other medical problems you may have, your physical examination, results of blood tests, and possibly the liver biopsy results. Your physician may need to change some of your HIV medications prior to starting hepatitis C treatment due to possible additive side effects from both sets of medications. In your case, he may want to change your Combivir to another agent due to the fact that one of the components of Combivir is zidovudine, which can worsen the anemia (low red blood cells) that is caused by hepatitis C treatment.
Finding an HIV Specialist™ is easy with AAHIVM’s Find-A-Provider directory at www.aahivm.org. Click on the “Find-A-Provider” window on the home page, enter your location, and click on the search button for a list of HIV Specialists™ near you.
For treatment of hepatitis C, there are currently two approved medications that need to be taken together and there are more in development. The medications currently approved are interferon, which is administered through injections, and ribavirin tablets and, in your case, treatment may take up to one year.
Depending on the type of your virus, the response to these medications can range between 20-70% successful. In contrast to HIV treatment, the medications for hepatitis C, if effective, are curative, so they do not need to be continued past the required treatment duration. In the vast majority of patients, once the duration of treatment is satisfied and the virus is cleared, the virus will not reappear. However, re-infection can occur if risky behavior is resumed.
There are several measures that you should try to pursue to keep healthy and decrease long-term complications from these two diseases. Due to differences between patients and their concomitant health conditions, the following recommended measures should be discussed with your physician.
- Avoid any future risky behavior, smoking, or alcohol. This will decrease transmission of these viruses and help to avoid further liver damage.
- Keep active and slowly improve your exercise capacity.
- Eat healthy, increase your fiber intake, keep your cholesterol down, and get moderate amounts of sun exposure to keep adequate levels of vitamin D (some medications or skin conditions may contraindicate sun exposure).
- Avoid weight gain and slowly lose extra weight naturally, as it keeps your liver healthy and improves your response to hepatitis C medications.
- Follow up closely with your physician and take your medications as recommended.
—Albert Malek, MD, AAHIVS
Atascadero State Hospital
Central Medical Services