David Scondras is lead writer of the ‘Reasons for Hope’ HIV treatment articles from Search for a Cure, a treatment advocacy group based in Boston, USA. He was asked to answer two questions for PN’s readers: what are the current treatment options for people with HIV and hepatitis C? And which may be available soon?
 illustration: chris keegan |
Hepatitis C is the most common blood-borne illness in the USA and western Europe. It attacks the liver. Scientists call the hepatitis C virus HCV, but it is commonly referred to as hep C.
There are four kinds of hep C called genotypes 1-4. Unfortunately the most common kind, especially in the US, is genotype 1 which is also the hardest to cure.
About ten to 20 per cent of people infected with hep C will clear the infection from their body. Many others have hep C their whole life but do not get sick from it.
But many do get sick. It takes people with hep C alone on average over two to three decades before they get very sick. Eventually the liver damage can lead to scarring of the liver (cirrhosis) and, in 20 to 30 per cent of individuals, liver failure.
Some studies show that HIV makes hep C destroy the liver faster than it does in people who have hep C alone.
People with HIV and hep C can develop liver damage within 15-20 years on average and in some cases in as short a time as five to 10 years, though not everybody develops severe liver disease. It is important to be evaluated to see how much damage has occurred. Lower CD4 counts and high alcohol consumption are related to faster liver damage.
Having HIV and hep C is called co-infection. At least one in 10 people with HIV in the UK is co-infected with these two viruses, with up to 30 per cent co-infected in other EU countries. (Doctors also use ‘co-infection’ to refer to people who have hepatitis B and HIV, or tuberculosis and HIV.)
In the US and Europe, one of the causes of death that is increasing in people with HIV is hep C-related liver disease.
Sixty to 90 per cent of people who got HIV from intravenous drug use or other needle exposure have hep C as well. A study at veterans’ hospitals in the US found that 18 per cent of over 32,000 veterans with HIV also had hep C. Eight per cent of 38,000 HIV negative veterans had hep C.
It is also possible to get hep C in other ways. About 20 per cent of new cases of hep C are from sex. An upsurge in sexually-transmitted hep C has recently been recognised among gay men with HIV in London. It is not clear what kind of sex leads to increased risk of getting hep C, though exposure to blood appears to be a factor.
If you get tested early, within six months of getting infected with hep C,
some doctors feel there is a good chance you can be cured. So people with HIV,
and IV drug users and gay men who have ongoing risks for getting hep C, should
get checked regularly - at least once a year.
It’s especially important to get tested for hep C if you have HIV or had a blood transfusion before July 1992, or were treated for clotting problems with blood products before 1987 (these are the years before these products began screening for hep C). Or if you have ever injected street drugs, even once, years ago.
Even though hep C is the leading bloodborne disease in the US, not enough attention is being paid to it. There is no regular testing for the disease, even though there is an inexpensive test for it. We do not know exactly how many people with HIV have hep C or which states or cities have the most.
This is not an accident. Medical care systems in the US and UK do not have the capacity to test and treat everyone who has hep C because the therapy is very expensive. And since most people who get hep C are people who are injection drug users, there is little political will to help.
There is a therapy for hep C. It only has a 40 per cent cure rate in people with hep C genotype 1 virus and who don’t have HIV, though cure rates for genotypes 2 and 3 approach 80 per cent. Even if people are not cured, hep C therapy does help many more stay better by slowing down the liver damage.
However, hep C therapy is very difficult to stick with because it has bad side effects. Most co-infected people have to take it for up to a year, and co-infected people also have lower cure rates.
The only US and EU-approved therapy for hep C involves taking two drugs: one every day by mouth, and the other once a week by needle.
The drug by needle is alpha-interferon, a natural antiviral chemical the body already makes. The drug by mouth is an antiviral called ribavirin.
The best way to take the interferon is using a time-release form of it called ‘pegylated’. It means that you only have to inject yourself once a week and it will keep your interferon level up for a week.
The pill, ribavirin, is taken twice a day, in the morning and early in the evening. You should take ribavirin in the early evening, never later, because it causes sleep disorders.
Some people get very sick on interferon especially during the first few weeks with sweats, chills, headaches, fevers - symptoms that are similar to the flu.
Another possible side effect is severe, sometimes suicidal depression. For this reason, people on hep C therapy are often given antidepressant drugs like Seroxat or Prozac.
Other side effects can include a serious drop in the number of your red and white blood cells. There are medicines to help if this happens, which is why the therapy has to be monitored carefully.
Since hep C attacks the liver, it is also important for people with it to try to not drink too much alcohol. When the liver is damaged it can be hard for the body to digest fat.
Dietitians suggest being very careful to avoid sugar and sugary foods, to keep protein intake up including foods like beans, tofu, nuts and dairy products, to cut back on fat, avoid oils and butter and to lose weight. Unfortunately, because the amount of medicine given to people is not adjusted by weight, people who are obese may not get enough of it.
It is also important to not take supplements or eat foods that contain high amounts of iron. Too much iron can lead to liver damage whether you have hep C or not. However for those who get anaemia from the medicines used to fight hep C, iron may be given to help fight the anaemia.
It is also vital for people with hep C to be vaccinated against hep A and hep B, assuming they have no pre-existing immunity. A second liver infection on top of a first will almost certainly speed up liver damage.
The good news is there are companies trying out drugs that look very good and will be a lot easier to use. Some of these new drugs may shorten the length of therapies. As of writing there are 24 studies that are open in the US studying new approaches to curing hep C, several of which are also open to UK patients.
For example, Boehringer Ingelheim (BI) has discovered a protease inhibitor which produced quick reductions in the amount of hep C in 31 people. Unfortunately, they are temporarily going back to the drawing board; two monkeys got side effects from the drug sufficient for the US Food and Drug Agency to say it might not be allowed to be used on people. But word is BI is looking for a version of the drug that does not have this side effect and that they are optimistic they will find one.
GlaxoSmithKline is also looking at a drug that attacks another part of the hep C virus, and will start human trials this year.
Three other therapies are being tested to see if they help interferon and ribavirin cure hep C. They are:
These are not the only drugs that are being tested and most scientists feel that we will soon have better therapies for hep C. Until then, if you do not have hep C - protect yourself.
All articles in the Reasons for Hope series are reviewed by expert HIV doctors and scientists as well as an HIV positive and negative focus group to ensure both accuracy and understandability. This article was reviewed by Dr Cami Graham, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA. Positive Nation would also like to thank Drs Ray Brettle, Sanjay Bhagani, Sandra Mead and Mark Nelson. Search For A Cure is a not-for-profit organisation providing education, promoting access and advocating the basic human right to safe and effective treatment for all people living with HIV/Aids. Search For A Cure: 34 Edgerly Road #1, Boston, MA 02115, USA. Tel 00 1 617 536 2474 Email: hope@sfac.org Website: www.searchforacure.org |
