Hepatitis C, HIV Co-Infections Spur Research Into New Treatment Protocols
Up to 40% of HIV-positive Americans are also infected with the hepatitis C virus, a trend that is changing the "medical landscape" for treatment of both diseases, the New York Times reports. The co-infection rate is as high as 90% for some subgroups, including HIV-positive intravenous drug users and hemophiliacs. Dr. Douglas Dieterich, chief of gastroenterology and hepatology at Cabrini Medical Center in New York, noted that while the rate of AIDS-related deaths is declining, liver disease due to hepatitis C has become the leading cause of death for HIV-positive patients in "many clinics." Further, studies indicate that HIV can "greatly" accelerate the progression of hepatitis C.
Treating the Deadly Duo
Antiretrovirals used to treat HIV place a "great strain" on the liver, and patients infected with both viruses may have difficulty tolerating many types of AIDS medications. Tari Gilbert, a nurse practitioner at the University of California-San Diego Treatment Center, said that many health care professionals believe that the best strategy is to "bring the HIV under control" before treating hepatitis C. But the Times notes that in order for this strategy to be successful, co-infected patients must be treated with HIV drugs that "boost the level of immune-fighting CD4+ cells, reduce the viral load and, equally important, are not unduly toxic to the liver." However, "research into the proper treatment of people with both viruses is still in its early stages." In an effort to focus on the issue, the San Francisco AIDS Foundation holds "regular internal briefings" for its staff on developments in hepatitis C research and "urges" new clients to get tested for hepatitis C "immediately." And in cities with high rates of both viruses, including New York, San Francisco and Los Angeles, a "handful" of physicians are "becoming known as specialists in both diseases." Some of these physicians helped established the Hepatitis Resource Network, a not-for-profit group based in Tacoma, Wash., that conducts clinical research on co-infection and distributes information about hepatitis C to physicians who treat HIV/AIDS patients. HRN Executive Director Lisa Ball said, "We've found that the easier approach is to educate HIV doctors about hepatitis C. The liver specialists often have their hands full with HCV patients who don't have HIV, and learning about all the HIV medications is incredibly complicated." Although treatment for co-infected patients is possible, most hepatitis C patients "can survive only with liver transplants," but this option is "routinely denied" to HIV/AIDS patients. The Times notes that as "awareness of the incidence of double infections grows," physicians have begun to research whether HIV-positive individuals can be "good candidates for transplants." But Dieterich said that "it will be years before we see what the long term results of these studies are" (Tuller, New York Times, 5/1).