About one fourth of HIV-infected persons in the United States are also infected with hepatitis C virus (HCV). HCV is one of the leading causes of chronic liver disease in the United States and HCV infec- tion progresses more rapidly, leading to liver damage in HIV-infected persons. HCV infection may also impact the course and management of HIV infection (some HIV medications cause liver damage).
The U.S. Public Health Service/Infectious Diseases Society of America (USPHS/IDSA) guidelines recommend that all HIV-infected persons be screened for HCV infection. Prevention of HCV infection for those not already infected, and reducing chronic liver disease in those who are infected are important concerns for HIV-infected indi- viduals and their health care providers.
HCV infection is viewed as an opportunistic infection in HIV-in- fected persons and was included in the 1999 USPHS/IDSA Guidelines for the Prevention of Opportunistic Infections in Persons Infected with Human Immunodeficiency Virus. It is not, however, considered an AIDS-defining illness. As highly active antiretroviral therapy (HAART) and prophylaxis of opportunistic infections increase the life span of persons living with HIV, HCV-related liver disease has become a leading cause of hospital admissions and deaths among HIV-infected persons.
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.
Not starting, or stopping injection drug use, eliminates the chief route of HCV transmission; substance-abuse treatment and relapse-preven- tion programs should be recommended. If patients continue to inject, they should be counseled about safer injection practices; that is, to use new, sterile syringes every time they inject drugs and never reuse or share syringes, needles, water, or drug preparation equipment.
How can HIV and HCV co-infected patients prevent further liver damage?
Individuals with evidence of HCV infection should be given information about prevention of liver damage, undergo evaluation for chronic liver disease and, if indicated, be considered for treatment. Persons co-infected with HIV and HCV should be advised not to drink alcohol. When appropriate, referral should be made to alcohol treat- ment and relapse prevention programs. While medicinal marijuana is indicated for persons with HIV, marijuana is very damaging to the liver. Patients co-infected with HIV and HCV should not use marijuana. Because of possible effects on the liver, HCV-infected patients should consult with their health care professional before taking any new medications, including HIV medications, over-the-counter, alternative, or herbal medicines.
When indicated, co-infected patients should receive hepatitis A and B vaccines. The vaccines appear safe for these patients and more than two-thirds of those vaccinated develop antibody responses.
Co-infected persons may be at increased risk for highly active antiretroviral therapy associated liver toxicity and should be closely monitored during antiretroviral therapy.