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
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
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,
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