Hepatitis C
Hepatitis C (often known as HCV) is a type of viral hepatitis that causes inflammation of the liver.
The liver is the largest internal organ in your body. Having a healthy liver is important for everybody, but it is especially important for people with HIV.Your liver has an essential role in processing medicines used to treat HIV and other conditions. Viral infections that affect the liver, such as hepatitis A, hepatitis B and hepatitis C, can make you ill and also mean that the liver is unable to process medicines properly.
When people have both HIV and hepatitis C, this is often described as 'co-infection'. If left untreated, liver disease caused by hepatitis C can be very serious. It is a major cause of illness and death in people co-infected with HIV.
Symptoms
Many people with hepatitis C have no symptoms at all. When they do occur they can involve tiredness, feeling generally unwell, stomach problems and jaundice – a yellowing of the skin and eyes.
However, even if you do not experience symptoms, the virus may still be damaging your liver.
This damage includes fibrosis – a hardening of the liver, which can lead to cirrhosis, which is permanent scaring of the liver. When this happens, the liver cannot work properly, causing serious illness. Cirrhosis increases the risk of liver cancer.
Hepatitis C may progress faster in people with HV who are not on HIV treatment. For this reason, co-infected patients are especially encouraged to start taking HIV treatment when their CD4 cell count is around 350.
Everyone with HIV should have regular tests to monitor the health of their liver. These tests are especially important if you have hepatitis C.
These include liver function tests that monitor levels of liver enzymes. Ultrasounds and scans are also important monitoring tools.
Sometimes it is necessary to have a liver biopsy. This involves the removal of a small amount of the liver under a local anaesthetic.
How it's passed on
Hepatitis C is normally transmitted by blood-to-blood contact. The main route of hepatitis C transmission in the UK is injecting drug use.
Hepatitis C can also be transmitted sexually. There has been an increase in the number of cases of sexually transmitted hepatitis C in HIV positive gay men.
Sex that involves contact with blood – for example 'fisting', when a hand is inserted into a rectum or vagina – seems to involve the greatest risk. Anal sex without a condom has also been identified as involving a risk of hepatitis C transmission.
Mother-to-baby transmission of hepatitis C is rare but the risks are higher if the mother has HIV, especially if she has a high hepatitis C viral load.
Ways you can protect yourself against hepatitis C:
There is no vaccine for hepatitis C and, unlike hepatitis A and B, having hepatitis C once does not mean you are then immune from getting it again. It is possible to be reinfected with the hepatitis C virus.
Tests and treatment
Everyone with HIV should be tested to see if they are co-infected with hepatitis C. A blood test for antibodies to hepatitis C is used to see whether you have been exposed to the virus. You might be given a PCR (viral load) test to confirm infection.
In people with HIV, the diagnosis of hepatitis C can be more difficult, as the infection may not show up on their antibody tests.
If you think you may be at risk of hepatitis C infection, you should have regular tests to see if you have been infected with the virus.
If you are HIV-positive and have hepatitis C infection, then you must receive care from a doctor skilled in the treatment of both HIV and hepatitis.
Treatment for hepatitis C is available. Unlike treatment for HIV, hepatitis C treatment is not for life – it usually lasts 24 or 48 weeks. The length of treatment depends on which strain – or genotype- of hepatitis you are infected with.
Genotypes 1 ands 4 are harder to treat. If you are infected with either of these genotypes then you’ll need to take treatment for 48 weeks.
Genotypes 2 and 3 are easier to treat, and their treatment normally lasts for 24 weeks.
The standard treatment for hepatitis C consists of two antiviral drugs - pegylated interferon and ribavirin.
These drugs may cause side-effects, which can be severe, but your doctor can give you other treatments to help reduce them. In addition, many people find that their side-effects become less severe, or go away completely over time.
The aim of this treatment is a cure - sometimes described as a ‘sustained virologic response’, which means that no hepatitis C virus is detectable in your blood six months after you’ve finished treatment.
Treatment for hepatitis C is more likely to work if you take it soon after you are first infected with the virus. It works less well for people who have had hepatitis C for a long time.
People who have hepatitis C are especially encouraged to start HIV treatment when their CD4 cell count is around 350. Taking HIV treatment can also improve the health of your liver and slow the damage caused by hepatitis C.
New types of drugs for hepatitis C are being developed. It is hoped that these will provide effective treatment for more people. It is not yet known whether they are safe and effective in people with HIV.
It's also important to understand how your hepatitis treatment may interact with your HIV medication. Find out more about HIV drug interactions.
This article was last reviewed on: 07/09/11
Date due for next review: 07/09/13
