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| {{Hepatitis C}}
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| {{CMG}}; {{AOEIC}} {{VK}} | | {{HIV coinfection with hepatitis c}} |
| ==Overview==
| | '''For main chapter on AIDS, click [[AIDS|here]]''' |
| HIV has been an important and familiar health and social crisis for two decades. Less familiar, but also important, is HCV infection. In HIV–HCV co-infected patients, the Hepatitis C (HCV) viral load is higher than in HCV-mono-infected patients in both the plasma and liver tissue.
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| '''Similarity between Hepatitis C with HIV:''' | | '''For main chapter on HIV, click [[HIV|here]]''' |
| These two viruses are similar in a number of ways, and infection with both is a serious problem. Both HCV and HIV are transmitted by
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| exposure to infected blood. About one-quarter of the people infected with HIV also have HCV.
| | '''For main chapter on Hepatitis C, click [[Hepatitis C|here]]''' |
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| ==Cause of Co-infection==
| | {{CMG}}; {{AOEIC}} {{VK}} |
| Patients who are HIV-positive are commonly co-infected with HCV due to the following:
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| *Shared routes of transmission.
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| *Percutaneous exposure to blood.
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| *Sexual intercourse.
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| *From a mother to her infant.
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| ==Pathophysiology== | | ==[[HIV coinfection with hepatitis c overview|Overview]]== |
| '''HIV’s effect on Hepatitis C:''' Studies have shown that HIV infection in a person who is also infected with HCV results in higher levels of HCV in the blood, more rapid progression to HCV-related liver disease, and increased risk for cirrhosis and liver cancer. As a result, HCV is now regarded as an opportunistic infection in people with HIV infection, although it is not considered an AIDS-defining illness.
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| ==Epidemiology== | | ==[[HIV coinfection with hepatitis c pathophysiology|Pathophysiology]]== |
| The majority of coinfected people are injection drug user (IDUs). HCV is acquired relatively soon after individuals begin injecting drugs. Within 5 years of beginning to inject, 50% to 80% of IDUs are infected with HCV. As a result, many IDUs who become infected with HIV are already infected with HCV. It is estimated that 50% to 90% of IDUs.
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| Between 1996 and 2000, more than 80% of the patients admitted to a large HIV/AIDS care center in Madrid, Spain, were IDUs. The proportion of these patients who were admitted because of liver failure almost doubled, from 9% to 16%.
| | ==[[HIV coinfection with hepatitis c causes|Causes]]== |
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| ==Natural History== | | ==[[HIV coinfection with hepatitis c differential diagnosis|Differentiating HIV coinfection with hepatitis c from other Diseases]]== |
| The effect of HCV on the natural history of HIV remains inconclusive due to contradictory studies documenting no effect, while others show an increase to an AIDS defining illness or death. The morbidity and mortality caused by HCV has increased since the inception of highly active antiretroviral therapy (HAART) because HIV patients are living longer from potent antiretroviral therapies and prophylaxis of traditional opportunistic infections. Infection with HCV can be asymptomatic, self-limiting, or progress to [[cirrhosis]] or [[Hepatocellular carcinoma|cancer]].
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| ===Complications===
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| End-stage liver disease is now the cause of death for 45% of HIV-infected patients in this hospital. HCV infection was the cause of the liver disease in nearly three-quarters of the HIV patients who were admitted or died during the course of the study.<ref name="pmid11709090">{{cite journal |author=Martín-Carbonero L, Soriano V, Valencia E, García-Samaniego J, López M, González-Lahoz J |title=Increasing impact of chronic viral hepatitis on hospital admissions and mortality among HIV-infected patients |journal=AIDS Res. Hum. Retroviruses |volume=17 |issue=16 |pages=1467–71 |year=2001 |month=November |pmid=11709090 |doi=10.1089/08892220152644160 |url=http://dx.doi.org/10.1089/08892220152644160 |accessdate=2012-03-27}}</ref>
| | ==[[HIV coinfection with hepatitis c epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Treatment== | | ==[[HIV coinfection with hepatitis c risk factors|Risk Factors]]== |
| The '''primary objective''' of HCV therapy is permanent eradication of the virus. The '''secondary''' potential benefit of eradication is a reduction in the risk of liver failure and liver cancer.
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| ===Role & Importance of treatment=== | | ==[[HIV coinfection with hepatitis c natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| The introduction in the mid-1990s of highly active antiretroviral therapy (HAART) for HIV has caused a sharp drop in the number of deaths from AIDS. This means that people with HIV are living longer. Therefore, if they are coinfected, the complications from
| | ==Diagnosis== |
| HCV have more time to develop. These complications (cirrhosis, liver cancer, end-stage liver disease) generally develop over 20-30 years.
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| Liver disease from HCV is now the leading non-AIDS cause of death in the U.S. in coinfected individuals with HIV. Treatment for each disease is complicated, expensive, and has side effects. This poses difficult issues for patients who are living with both HIV and HCV. Finally, coinfection is important because it has a disproportionate impact on certain communities, including those in prison and jail and communities of color.
| | [[HIV coinfection with hepatitis c history and symptoms|History and Symptoms]] | [[HIV coinfection with hepatitis c physical examination|Physical Examination]] | [[HIV coinfection with hepatitis c laboratory findings|Laboratory Findings]] |
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| ===Regimen=== | | ==Treatment== |
| The Food and Drug Administration (FDA) has approved two antiviral drugs for the treatment of chronic hepatitis C:
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| * [[Alpha interferon]] or an improved form of interferon, called [[Pegylated interferon alpha|pegylated interferon]]
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| * [[Ribavirin]]
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| Interferon is given alone or in combination with ribavirin usually for a 12-month period to patients with chronic hepatitis C who are at greatest risk of developing serious liver disease.
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| ==Recommendations for Diagnosis and Treatment of Persons with HIV Coinfection: AASLD Practice Guidelines 2009<ref name="pmid19554546">{{cite journal |author=Swan T, Curry J |title=Comment on the updated AASLD practice guidelines for the diagnosis, management, and treatment of hepatitis C: treating active drug users |journal=[[Hepatology (Baltimore, Md.)]] |volume=50 |issue=1 |pages=323–4; author reply 324–5 |year=2009 |month=July |pmid=19554546 |doi=10.1002/hep.23077 |url=http://dx.doi.org/10.1002/hep.23077 |accessdate=2012-02-21}}</ref>==
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| '''1.''' Anti-HCV testing should be performed in all HIV-infected persons ''(Class I, Level B)''.
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| '''2.''' HCV RNA testing should be performed to confirm HCV infection in HIV-infected persons who are positive for anti-HCV, as well as in those who are negative and have evidence of unexplained liver disease ''(Class I, Level B)''.
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| '''3.''' Hepatitis C should be treated in the HIV/HCV co-infected patient in whom the likelihood of serious liver disease and a treatment response are judged to outweigh the risk of morbidity from the adverse effects of therapy ''(Class I, Level A)''.
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| '''4.''' Initial treatment of hepatitis C in most HIV infected patients should be peginterferon alfa plus ribavirin for 48 weeks at doses recommended for HCV mono-infected patients ''(Class I, Level A)''.
| | [[HIV coinfection with hepatitis c medical therapy|Medical Therapy]] | [[HIV coinfection with hepatitis c prevention|Prevention]] | [[HIV coinfection with hepatitis c cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[HIV coinfection with hepatitis c future or investigational therapies|Future or Investigational Therapies]] |
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| '''5.''' When possible, patients receiving [[zidovudine]] (AZT) and especially didanosine (ddI) should be switched to an equivalent antiretroviral agent before beginning therapy with ribavirin ''(Class I, Level C)''.
| | ==Case Studies== |
| | [[HIV coinfection with hepatitis c case study one|Case #1]] |
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| '''6.''' HIV-infected patients with decompensated liver disease (CTP Class B or C) should not be treated with peginterferon alfa and ribavirin and may be candidates for liver transplantation ''(Class IIa, Level C)''.}}
| | ==Related Chapters== |
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| ==References==
| | * [[Coinfection]] |
| {{reflist|2}}
| | * [[AIDS]] |
| | * [[HIV disease]] |
| | * [[Hepatitis B with HIV coinfection]] |
| | * [[Tuberculosis and HIV coinfection]] |
| | * [[HIV and tuberculosis coinfection : drug interaction]] |
| | * [[HIV and pregnancy]] |
| | * [[Hepatitis]] |
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| {{WS}} | | {{WS}} |
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| [[Category:Hepatitis|C]] | | [[Category:Hepatitis|C]] |
| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Infectious disease]]
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| [[Category:Disease]]
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| ==References==
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| {{reflist|2}}
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| {{WS}}
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| {{WH}}
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| [[Category:Hepatitis|C]]
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| [[Category:Gastroenterology]]
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| [[Category:Infectious disease]]
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| [[Category:Disease]] | | [[Category:Disease]] |