It wasn’t that long ago that treating hepatitis C in people living with HIV was limited to two drugs: pegylated interferon and ribavirin. These medications were very challenging: People had to take them for a year, injecting one of them, suffering severe side effects, and worst of all, they were not a very effective cure. Today, HCV treatment is easier than ever—for most people it can be completed in 8–12 weeks (although some people may need 24 weeks), with few pills (and no injections!), and manageable side effects that are usually quite mild. Best of all, there’s a high cure rate—between 90 to 100%. These new treatments also work very well in people living with HIV. HIV infection might complicate treatment, but it’s nothing that can’t be managed, and you can still be cured of HCV.
Following are some key points for people living with HIV and HCV. This information comes from the recommendations from the Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents and from AASLD/IDSA HCV Guidance: Recommendations for Testing, Managing and Treating Hepatitis C, the two leading sets of professional guidelines for managing and treating HIV and HCV. They inform your medical providers in their practice, and offer valuable information for you, too. Read more at clinicalinfo.hiv.gov and hcvguidelines.org.
Managing HIV in co-infected persons
Managing and treating your HIV maintains your immune system and keeps your HIV viral load undetectable, but it’s also good for your HCV. HIV treatment slows down liver damage and reduces the risk of liver-related problems for people who are co-infected.
There could be drug interactions between your HIV and HCV medications, however. In these cases, you may need to switch your HIV regimen to accommodate the HCV treatment. If you can’t (or don’t want) to switch, you may be able to try an HCV treatment that doesn’t interact with your HIV meds. Make sure your HIV and HCV care providers both know about all the medications you’re taking so they can help you manage any potential interactions.
The most important thing is that you should not stop taking your HIV medication in order to take HCV treatment. You can take both at the same time.
HCV treatment in persons who are co-infected
Everyone with HCV should get treated, regardless of the amount of liver damage; persons who are co-infected with HCV and HIV are no exception. In fact, AASLD/IDSA Guidance states that people who are co-infected can be treated and re-treated with the same DAAs as those who are living with HCV alone.
The cure rates for people who are HIV/HCV co-infected are extremely good, closely mirroring the rates of people who don’t have HIV. Hepatitis C DAAs are easy to tolerate, and the medications have few side effects. There’s never been a better time to treat HCV.
When to begin HCV treatment for co-infected persons
As soon as possible. Co-infected persons who are cured of HCV have a lower risk of liver problems down the line. The sooner you get cured, the less likely the liver damage. Even if you find out that your liver has more advanced damage, getting cured reduces the risk of long-term consequences. Additionally, depending upon how much damage there is, you might even be able to reverse it.
The only time you might consider holding off on HCV treatment is if your CD4 cells are below 200. If this is the case, it might make sense to wait a bit until your HIV medications can suppress the virus and give your immune system a chance to recover. Talk with your medical provider about the best course of action.
Maximizing treatment effectiveness
Adherence to your HIV medications is extremely important for keeping your viral load suppressed and to minimize the risk of developing drug resistance. The same is true for your HCV medications: The better you are at taking them, the better your chance at achieving the cure.
Adherence is more than just taking the pills every day. It includes taking them as prescribed to avoid drug interactions that might weaken the DAA’s effectiveness. Check with your medical provider about everything you’re taking—prescribed, over-the-counter, or recreational—to make sure you can take them safely and to maximize your chance at a cure.
Preventing reinfection after treatment
You can get hepatitis C more than once. After you’ve been cured, it will still be important to prevent re-infection with HCV. If you inject drugs, use new syringes and injecting equipment, and avoid sharing them. People who are HIV-positive are more vulnerable to sexual transmission of HCV, so minimizing your risk of exposure to HCV through safer sex practices (condoms for anal sex and gloves for fisting, for example) and other forms of harm reduction can offer you protection from re-infection.
After you’ve been cured, and if you have ongoing risk that could lead to re-infection, you’ll want to get tested by taking a viral load test (you’ll always have HCV antibodies) to check for HCV.
Manage other potential liver conditions
People living with HIV are at great risk for having “non-alcoholic fatty liver disease,” or “NAFLD,” even in the absence of HCV or HBV. NAFLD is related to metabolic disorders that are common in people living with HIV, including diabetes, high cholesterol, and obesity (high body-mass index, or BMI; a clinical way of saying “overweight”). These lead to excess fat getting stored in a person’s liver that can lead to problems over time, including cirrhosis and liver cancer. Talk to your medical provider about your risk of NAFLD and monitor liver health after you’ve been cured of HCV. There are no current treatments for NAFLD, but many are being studied. Follow POSITIVELY AWARE for updates on NAFLD research news and its treatment.
Closing
We can end co-infection. Through improved HCV awareness, routine HCV testing, and expanding HCV treatment, the health and wellbeing of people living with HIV will improve. It’s not always easy, but we have the tools and the ability.
If you have questions about HCV treatment, call The Support Partnership’s national hepatitis C helpline: HELP-4-HEP, (877) 435-7443.