What is Co-infection?
Co-infection occurs when a person is infected with two or more blood-borne
viruses.
In Australia, the most commonly recognized type of co-infection is
hepatitis C together with hepatitis B.
It is estimated that 2-5% of people with hepatitis C are co-infected
with chronic hepatitis B. Treatment and management issues for a person
with co-infection are complex, with the available research information
constantly being updated.
Information about management of co-infection is best provided by a
liver specialist, a gastroenterologist or an infectious diseases specialist.
In the presence of chronic hepatitis C, hepatitis A can become life-threatening.
Chronic hepatitis B can interact with hepatitis C to increase the severity
and rate of development of liver disease.
Therefore, if there is not prior evidence of infection with either
hepatitis A or B in people with hepatitis C (this can be established
through blood testing), immunisation against both viruses is strongly
recommended.
Hepatitis C – HIV Co-infection
What are HIV and AIDS?
Acquired Immune Deficiency Syndrome (AIDS) was first described in North
America in the early 1980’s and in 1985 the Human Immunodeficiency
Virus (HIV) was found to cause AIDS.
HIV is the Human Immunodeficiency virus
What is Hepatitis C – HIV Co-Infection?
When a person has HIV and hepatitis C, this is referred to as co-infection.
Research has shown that hepatitis C progression can be quicker and
more severe in HIV-infected individuals because HIV infection causes
decreased immunity, thus allowing hepatitis C to progress more easily.
In the presence of HIV-related damage to the immune system, management
aims to reduce the chances of hepatitis C becoming a life-threatening
infection.
The longer a person has had HCV/HIV, the more likely it is that HCV
has progressed.
One small study suggests that intervention with HIV therapy (HAART)
may slow or stop HCV progression for some individuals.
HCV treatment may be successful in stopping or slowing progression
of the HCV virus.
In terms of the interaction between these two viruses, most is known
about the effect of HIV on hepatitis C, rather than the effect of hepatitis
C on HIV.
As with HCV, people with co-infection should be tested for hepatitis
A and hepatitis B. If negative, they should talk to their doctor about
vaccination for these viruses.
Who is most at risk for Hepatitis C-HIV Co-infection
1. People who became infected with HIV through blood to blood contact
via injecting drug use practices.
2. People with conditions such as Haemophilia who were treated with
blood products before 1990.
3. Men who have sex with men and who inject drugs.
4. Children born to women with co-infection.
The current number of people in Australia with hepatitis C and HIV
co-infection is thought to be relatively low.
It is estimated that less than 1% of people with hepatitis C also have
HIV.
In people who inject or have injected drugs and who are HIV positive,
hepatitis C rates are as high as 90%.
The majority of people with haemophilia who have HIV, also have co-infection
with hepatitis C
What is the treatment for HIV-HCV co-infection?
In the late 1990’s, a highly effective anti-HIV therapy (known
as HAART) transformed HIV/AIDS from a disease that was regarded as often
fatal to one that is potentially manageable long-term.
Current drug treatment for Hepatitis C consists of a combination of
Interferon and Ribavirin for a period of 6 to 12 months.
Co-infection is a complex issue and people need to find a doctor who
is knowledgeable about both HIV and HCV to discuss treatment strategies.
Discussions should include consideration of the benefits and risks of
immediate or 
deferred
HCV treatment and which treatment should be started first (HIV or HCV).
Each person’s situation is different, and treatment decisions
should consider the individual’s condition, the potential outcome
of treatment, potential side effects of treatment and the disease stages
of their HIV and HCV.
In order to properly assess a person’s HCV health status and
potential outcome of treatment, certain laboratory tests need to be
performed and perhaps an ultrasound x-ray and liver biopsy.
Current Response to HCV Treatment (for more detailed information see
section on Hepatitis C)
Overall, about 40% of patients achieve a Sustained Virological Response
(SVR) using Combination therapy (Interferon plus Ribavirin). The SVR
is defined as undetectable HCV viral load at end of treatment and six
months after cessation of treatment.
This response rate is based on large studies in individuals with HCV
alone. In these studies, individuals with genotype 1 (the most common
strain of hepatitis C in Australia) achieved a 30% response rate; Genotypes
2 or 3 achieved a 65% SVR.
The use of Pegylated interferon with ribavirin has been shown to increase
response rates even further. Pegylated interferon will be available
in the near future.
Factors which may affect a co-infected person’s ability to respond
to therapy include their overall health, how long they have had HCV,
the HIV viral load, the HCV viral load, CD4 count, the condition of
the liver (amount of scarring), age, gender and alcohol intake.
A number of ongoing studies are looking closer at these questions.
What is the expected response to treatment
for HIV/HCV co-infection?
In several recent small studies, the response of co-infected individuals
to HCV treatment was about the same as for people with HCV alone.
Factors which may affect a co-infected person’s ability to respond
to therapy include their overall health, how long they have had HCV,
the HIV viral load, the HCV viral load, CD4 count, the condition of
the liver (amount of scarring), age, gender and alcohol intake.
A number of ongoing studies are looking closer at these questions.
Local Contacts for Hepatitis C/HIV Co-infection
GOLD COAST SEXUAL HEALTH SERVICES – Miami Central
Health building, 2019 Gold Coast Hwy, Miami. Ph: 07 5576 9033.
Web Site:
www.acshp.org.au/Miami.
THE IMMUNOLOGY CLINIC – Specialist Outpatients
Dept, Gold Coast Hospital. Ph: 07 5571 8246.
Other Interesting Web-sites for HIV/Hepatitis
C Co-infection
Australian
www.ahcahrd.org.au
– Australian National Council on AIDS, Hepatitis C and Related
diseases
www.ashm.org.au
– Australian Society for HIV Medicine (ASHM)
www.hepatitisc.asn.au
– Hepatitis C Council of Queensland
International
www.natap.org –
National AIDS Treatment Advocacy Project (NATAP)
