AIDS 2014: New Hope for Those Living With HCV/HIV Co-infection
Dr. Henry Lik-Yuen Chan
Life can be challenging for the 130 to 170 million people across the world who have the hepatitis C virus (HCV), a viral infection that impacts the liver. For those living with HIV and hepatitis C, the path to living a healthy life has been particularly arduous. However, new HCV drugs spotlighted during AIDS 2014 are changing that.
Hepatitis C is transmitted when blood from an infected person enters the body of an uninfected person. The most common way for it to be transmitted is through the sharing of needles or syringes during injection drug use. Less common ways of getting HCV include accidental needle pricks in healthcare settings, sexual contact and mother to child transmission during childbirth.
For some people, hepatitis C is an acute infection that can clear up on its own. However, for between 75 percent and 85 percent of people who become infected with hepatitis C, it becomes a chronic condition that can last a lifetime, causing problems such as cirrhosis of the liver and liver cancer.
Among people co-infected with HIV and HCV, there are other concerns.
* Those who are co-infected with both diseases often experience a faster HCV progression.
* People co-infected with HIV and HCV often experience dysfunction in multiple organs, such as cardiovascular issues or neurologic disease.
* People who are co-infected with HIV and HCV often have a higher risk of heptatotoxity—liver damage that results from the use of certain medications.
Having HCV and HIV creates "double trouble for the liver," said Sanjay Bhagani, M.D., a consultant, physician, and senior lecturer with Royal Free, a hospital center in London. Bhagani discussed some of the latest HCV treatments at a session at AIDS 2104 called "HCV Cure: New Treatment Paradigms for HCV Infection."
Since an HCV and HIV co-infection can wreak so much havoc on one's health, researchers have recognized that finding a cure for HCV would also improve outcomes for people living with HIV.
A New Day for Treatment
In the past, the main way to treat HCV has been through the use of interferon-based drugs. However, interferon posed a number of treatment challenges, said AIDS 2014 presenter Henry Chan, M.D., assistant dean, faculty of medicine, with the Chinese University of Hong Kong.
In a presentation called "The Global Burden of Hepatitis Infection," Dr. Chan described how interferon-based drugs often lead to painful side effects and require a lengthy treatment regimen that could take about a year. Studies have also shown that people co-infected with both HIV and HCV often don't respond well to interferon-based treatments.
But a new day is dawning in the treatment of hepatitis C. New medications called direct-acting antivirals (DAA) are presenting some impressive results, curing many of those who have tried them of HCV entirely. DAAs also are easier for people living with HCV to bear since they don't come with the same side effects as the interferon-based drugs, and the treatment regimen can be as short as 12 to 24 weeks.
For those living with HIV and hepatitis C, the news is particularly good. Researchers have found that people living with HIV are responding as well to the DAAs as people who don't have HIV so unlike with interferon-based drugs, people living with HIV aren't at a disadvantage. "For the first time ever, people co-infected with HCV and HIV are no longer the poor cousins of hepatitis C mono-infected patients," Dr. Bhagani said.
New Recommendations Issued
Researchers working to cure HCV have been so excited by DAAs that the European Association for the Study of the Liver issued new guidelines in April for treating HCV in which they recommended that the same treatment regimens be used in patients co-infected with HIV as in patients that do not have HIV.
While there is much to be excited about, there is still much research to be done. For people living with both HIV and hepatitis C, there could be complications that arise from the drug interactions between DAAs and the antiretrovirals used to treat HIV, Dr. Bhagani warns.
Another challenge to widespread use of the new medications is the price tag. For example, one of the new drugs, Sovaldi by pharmaceutical company Gilead Sciences, currently sells on the market for $84,000 for a 12-week regimen, a price tag that has sparked outrage. While some insurance companies cover the cost, other insurers have limited who can immediately get access to the drug.
But despite the issues that remain to be worked out, there is plenty of reason to celebrate, and much excitement at AIDS 2014 about the future for people living with HIV and hepatitis C.
Tamara E. Holmes is a Washington, D.C.-based journalist who writes about health, wealth and personal growth.