Oct. 26, 2001 -- Liver disease is emerging as a leading killer of people with HIV because many are also infected with the liver-damaging hepatitis C virus. Newly available hepatitis C drugs offer the greatest promise yet for the prevention of liver damage and death. But treatment remains complicated for people infected with both viruses, a top researcher says.
AIDS deaths plummeted in the mid 1990s following the introduction of highly-active combination treatments that help keep other potentially-deadly infections at bay. Figures from the U.S. and Western Europe show that even though fewer people than ever are dying from AIDS, more and more people are succumbing to liver disease related to hepatitis C infection.
About 1 million people in the U.S. are infected with HIV, and a third of them are also infected with hepatitis C. Like HIV, the hepatitis C virus is spread by contact with an infected person's blood. It is estimated that about 90% of people who acquire HIV through intravenous drug use also have hepatitis C, compared with only about 10% of those who become infected with HIV through sexual contact.
HIV infection makes diagnosing hepatitis C more complicated, and at the same time it also makes the hepatitis C virus cause liver damage more quickly than it normally would. Before the newer HIV drugs were introduced, very few people infected with both HIV and hepatitis C ever received hepatitis C treatment. They died of AIDS before any signs of liver damage became evident.
But it has become clear that doctors can no longer ignore hepatitis C in people infected with HIV, says one of the nation's leading experts in both viruses.
"There is a growing recognition today that we need to address the issue of treating hepatitis C in patients infected with HIV, but there have been few studies addressing this population," Mark S. Sulkowski, MD, tells WebMD. He is an assistant professor in infectious diseases at Baltimore's Johns Hopkins School of Medicine. "There is a big hope that the new medications will be effective for some. But many patients don't respond, and these drugs have side effects which make them particularly difficult to use in this population."
Speaking today at the 39th annual meeting of the Infectious Disease Society of America, in San Francisco, Sulkowski presented data from a study evaluating a treatment for hepatitis C in people also infected with HIV. He reported that daily injections of the hepatitis C drug interferon, combined with the drug ribavirin, were more than twice as effective as the standard, three-times-a-week treatment.
Sulkowski said a widely-anticipated therapy, which became available several weeks ago, should make it easier to treat people with hepatitis C. PEG-interferon is a long-acting version of the drug that requires weekly, rather than daily, injections.
In the Johns Hopkins study, side effects were a real problem, Sulkowski says. Almost a quarter of the people enrolled in the 12-week study stopped treatment early due to side effects such as anemia and depression.
"We are learning that in a population of people with HIV, these side effects can be particularly troublesome," he says. "If we are going to use these medications effectively, we need to better manage these side effects by using drugs to control anemia and antidepressants to manage depression."