HEP C Co-infection
Hepatitis C Virus (HCV) is an infectious blood-borne-virus (BBV) that can affect the liver when left undiagnosed and untreated. HCV may eventually cause liver fibrosis (hardening) and more rarely liver cancer (1% of people).
New highly effective pill-based treatments for HCV have now become available on the PBS since 01 March 2016. This is an exciting new medical breakthrough! The new treatments can cure Hepatitis C (HCV) in up to 90% of people with HIV/HCV coinfection, for most (geno)types of Hepatitis C (HCV), by taking 1 or 2 HCV pills daily. These new treatments are called “Direct Acting Antivirals” (DAAs), and their side effects are very low. Rarely now will the old HCV treatments of interferon (injectable) treatment be used, and certainly it will no longer will be used for 6 – 12 months (as was the previous HCV treatment protocol). The new Hepatitis C treatments now offer the chance for HIV-positive people to clear the Hepatitis C Virus (HCV), in up to 90% of cases using the new DAAs for up to 12 weeks. This is good news because having HIV and HCV increases the chances of liver-related health problems from having Hepatitis C (HCV). So having HCV coinfection can make HIV outcomes worse, and can increase HIV viral load. It is not as well known what effect HIV may have on HCV.
The new Hepatitis C (HCV) treatments can effectively clear the main common HCV types (known as ‘genotypes’ or ‘strains’), also for people who do not HIV, providing a “sustained virological response (SVR)” which is regarded as ‘cure’. In the past some different types (strains) of HCV did not respond as well to treatment, but this is far less the case now since the new DAAs are highly effective for most strains.
Some people can naturally clear the HCV virus early (soon after infection) without taking any treatment (20% of people); but if you have HIV as well approximately 15% of people with HIV/HCV will clear the virus early without any treatment. If you have ‘chronic’ (longer term) HCV infection then you have not cleared the virus naturally, and so treatment will be required as advised by your doctor.
If you are considering Hepatitis C (HCV) treatment have a discussion with GP, HIV Physician, Liver or Infectious Diseases Specialist.
It is important to note that these new HCV treatments are NOT a vaccine, and therefore do no prevent you from getting Hepatitis C – they are a treatment for an existing HCV infection in order to potentially clear the hepatitis C virus. If you are successful in clearing HCV it’s important to know you can be re-infected with HCV again a second time around. The risk of getting HCV is increased by sharing injecting drug equipment or needles – to avoid this risk use clean needles and syringes and your own equipment (and dispose of needles and equipment safely in an approved sharps container). Also avoid sharing personal grooming items (e.g. razors, toothbrushes, clippers, tweezers). HCV can also be sexually transmitted, and is this route of transmission is increasing among gay men and other men who have sex with men (MSM) when condoms are not used during anal sex or through sharing unwashed sex toys and group sex and fisting (where there may be abrasions, tears, cuts, wounds or sores that may not be easily seen increasing blood to blood exposure to HCV).
Treating Hepatitis C Resources
The New Deal is a new website for gay men, particularly those living with HIV, about the sexual transmission of hepatitis C and how to prevent it. The website includes info about testing, treatment and HIV/hepatitis C coinfection.
For updated information about Treating Hepatitis C, please see the following links:
- Queensland Positive People – article on the New Hepatitis C treatments for people with HIV/HCV coinfection: https://www.qpp.org.au/latest/the-end-to-hepatitis-c
- Hepatitis Queensland – have a range of resources about Hepatitis A (HAV), Hepatitis B (HBV), and Hepatitis C (HCV), including updated information about treatments. Call 1800 HEP ABC to find out more.
- HIV and Hepatitis – an information website about HIV & HCV.
- ASHM – The Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) contains patient and clinic information for the management of HIV and Hepatitis C co-infection.
If you have any questions about Hep C co-infection, please call QPP’s Health Education Officer toll-free from a QLD land-line on 1800 636 241, or use the contact form provided or call (07) 3013 5555 (nationally).