HIV and hepatitis

All the reports in this edition of HIV Weekly are concerned with hepatitis.

Many people with HIV also have hepatitis B or hepatitis C. This is often referred to as ‘co-infection’. The liver disease that these infections can cause is now a major cause of illness and death in co-infected patients.

There’s a lot you can do to protect yourself against these viruses. They can also be treated.

There is a lot of information available about hepatitis B and hepatitis C. A good place to start is the section on hepatitis on our website namlife.org, or you could visit the hepatitis topics pages on our website aidsmap.com, to see all our hepatitis publications.

NAM also produces a free booklet on HIV and hepatitis.

In the UK, the Hepatitis C Trust offers support and information on all aspects of living with hepatitis C through their helpline: 0845 223 4424; the British Liver Trust offers support and information on all types of liver disease, you can contact them on 0800 652 7330.

HIV and hepatitis C – the epidemic in France

Approximately 25% of HIV-positive patients in France are co-infected with hepatitis C. Researchers have looked at the characteristics of these patients and the implications of co-infection.

A total of 1175 people were included in the analysis. Their HIV profile was reasonably good. The average CD4 cell count was 442, 72% were taking HIV treatment and 68% had an undetectable viral load.

Most of the patients had been infected with hepatitis C through injecting drug use.

A variety of tests were used to assess the liver damage caused by hepatitis C. Depending on which test was used, between 27 and 46% of patients were found to have cirrhosis – permanent scarring of the liver.

Just over half the patients received hepatitis C treatment. But responses were poor. Only 34% of patients who were taking treatment for the first time cleared their hepatitis C infection.

A total of 49 patients died, and 41% of these deaths were directly attributable to hepatitis C.

Having cirrhosis or a low CD4 cell count increased the risk of death.

Some people experience depression as a symptom of hepatitis C or a side-effect of its treatment. The researchers found that treating this not only improved patients’ mood, but also helped with other symptoms such as tiredness.

HIV and hepatitis C – predicting the success of treatment

Researchers have developed a new tool that helps them to predict which patients will respond to treatment.

It’s based on tests that can be performed as part of routine care. None of them requires a liver biopsy. The tool can be downloaded for free here.

The researchers used four test results to predict outcomes:

• hepatitis C viral load.

• hepatitis C genotype.

• liver stiffness.

• genetics.

All four of these factors have a role in predicting response to treatment.

It’s already well known that people with a high hepatitis C viral load are less likely to respond to treatment.

Poorer responses to therapy are also seen in people who are infected with hepatitis C genotypes 1 and 4.

But liver stiffness is a new predictor of treatment success. It’s assessed using a test called FibroScan. This involves placing a small instrument against the skin above the liver. The test can tell how damaged the liver is and if a person has fibrosis or cirrhosis.

Finally, it’s been shown that people who have a certain genetic mutation are less likely to respond to hepatitis C treatment.

The researchers tested the accuracy of their tool on two groups of co-infected patients in Spain. It was shown to be highly reliable.

Hepatitis B – vaccination

Another virus that can cause serious liver problems is hepatitis B, and many people with HIV are co-infected with hepatitis B.

A vaccine is available against hepatitis B. It is recommended that everyone who is HIV-positive receives this vaccine.

It’s provided in three doses over a six-month period via injections. To make sure that you’re protected against the virus, it’s important to have all three injections.

After vaccination, your immunity to hepatitis B will be checked regularly to see if you need a ‘booster’ dose.

However, some people don’t return to the clinic for all three doses of the vaccine. Researchers therefore wanted to see if it was possible to provide the vaccine in a shorter, accelerated time period.

Their study involved drug users. Half received the vaccine over the normal six-month period, the others over two months.

Overall, about 75% of people received all the required doses. There was no real difference in the proportion of patients in the standard and accelerated vaccination arms who completed treatment.

But people who injected drugs were more likely to receive all three doses of the vaccine if they were in the accelerated arm (75 vs 66%).