HCV and HIV Co-infection

There are a significant number of people who are living with both HIV and HCV, with this population there are added issues that can impact their quality of life and progression of disease, which the mono-infected population do not face.

We now have therapy for HIV that can manage the virus effectively, and life expectancy is similar to non- HIV+ people. Add HCV and things get further complicated. I know a number of HIV/HCV co-infected people who have seen their hepatitis c cured, which is great news because of their increased risks of living with both.

Co-infected people often see a much faster progression of fibrosis (liver damage) and they are at higher risk for other issues that can diminish their health outcome. With hep c eradicated they do much better as long as they continue treatment for HIV and can keep their viral load in check.

The numbers of co-infected persons has risen in recent years despite our improved understanding, and regardless of what data we choose to believe is accurate there is no question that a significant number of people who have HIV are also co-infected with HCV. This is not true inversely, with the greatest majority of people who are living with HCV being mono-infected with hep c only.

As to causes of co-infection, one of the most common routes of transmission for new HCV infection is the sharing of drug use equipment of which needles for injecting is the highest risk because it is blood to blood. There is some evidence that infection of HCV can occur through sexual activity but this remains controversial and disputed, even in the face of studies, which point to risks associated. Taking precautions to mitigate risk is still our best approach with HIV, HCV or other well-known STI’s (sexually transmitted infections).

It is common to test for HIV when looking at testing a person for HCV and should be done at the same time in my view-either way, meaning that if the primary objective is to test HIV why not test HCV and vice versa. We are remiss if we do not look at both.

I believe we still have some distance to go before we see a real and meaningful response to HCV globally, and here at home where we receive health care, but with treatment for HIV commonly available, we hope that sooner rather than later we will see the same for HCV, given that we are seeing a greater number of people being diagnosed with end stage liver disease and liver cancer, not to mention worsening quality of life for those who do not have advanced liver disease.

If you have been diagnosed with HIV make sure you have been tested for HCV, and for those who are living with chronic hepatitis c please make sure you have been tested for HIV regardless of your perceived risk factors.

Prevention is key if we are ever going to stem the tide of new infection with both, and although their modes of transmissions vary somewhat, we need to be aware of the risks and take the steps necessary to protect ourselves, and those we may put at risk.