Hepatitis C and Other Health Conditions
Hepatitis C and HIV
Co-infection with hepatitis C and HIV occurs due to a common mode of transmission. Although there currently are no estimates on the prevalence, studies estimate that approximately 10% of people are co-infected. People with both HCV and HIV tend to have higher viral counts of HCV in their blood and livers compared with people infected only with hepatitis C.
HIV appears to accelerate HCV disease progression approximately four times faster than the disease progression in HCV-infected individuals who do not have HIV. Approximately 25% to 50% of patients co-infected with HIV and HCV are thought to progress to cirrhosis, compared to approximately 20% of individuals infected with HCV alone. Conversely, HCV appears to have no effect on the progression of HIV to AIDS. HCV-related mortality is currently more common than HIV-related mortality in co-infected patients.
Co-infection appears to increase the chance that HCV will be sexually transmitted. It also appears to increase the chance that a mother will infect her unborn child with the virus. This may be due, in part, to the high viral count in this subset of patients.
Treatment for HCV infection should not be withheld because a patient has concurrent HIV infection. Pegylated interferon plus ribavirin is the treatment recommended if the HIV patient exhibits no signs of disease progression to AIDS. However, once AIDS develops, alfa interferon is less effective.
Hepatitis C and Hemophilia
Before routine and effective hepatitis C screening of the blood supply was established in 1990, many hemophiliacs received HCV-infected blood products. Approximately 70% to 80% of hemophiliacs carry HCV, though the percentage is declining year after year as fewer new cases develop.
Although some people with hemophilia were infected with HCV multiple times, from multiple blood products, their disease progression does not appear to be any more severe than the disease progression in HCV-infected individuals without hemophilia. In general, HCV-infected hemophiliacs whose condition is not further complicated with HIV infection are treated with a pegylated interferon-based regimen.
Hepatitis C and Kidney Transplantation
Approximately 10% to 49% of kidney transplant recipients have antibodies for hepatitis C in their blood. Chronic HCV infection in these individuals appears to carry twice the risk of a serious post-transplant infection, compared to kidney transplant patients who do not test positive for HCV antibodies. However, there is no data indicating that HCV-infected kidney transplant recipients have a higher rate of transplant rejection or death.
Pegylated interferon-based treatment is not recommended for HCV-infected kidney transplant recipients, because the treatment puts them at a high risk for transplant rejection. Sometimes these patients are treated before receiving a transplant.
As in the general population, co-infection with both hepatitis C and hepatitis B appears to hasten disease progression in kidney transplant patients, increasing their risk of liver failure and death.