There have been a number of studies showing that HIV can have a negative
effect on the way HCV acts in the body. For starters, HIV can increase
the chance that someone with chronic HCV infection will experience cirrhosis
of the liver. As discussed in the last question, approximately 20 to 25
of every 85 people with healthy immune systems who have chronic HCV infection
will go on to develop cirrhosis of the liver within 20 years. If HIV is
also present, approximately 30 to 35 of every 85 people will likely experience
cirrhosis.
HIV infection can also speed up the rate by which HCV infection causes
cirrhosis of the liver. In one study, people infected with both HIV and
HCV were twice as likely to have cirrhosis of the liver after 13 years
than people only infected with HCV (15% vs. 6%). Similar results have
been seen in other studies.
It is also true that people with HIV and HCV are more likely to experience
liver failure – which is often fatal, unless a transplant is performed
– than people infected only with HCV. In one study, people infected
with both viruses were 21-times more likely to die of liver failure than
those only infected with HCV.
Another issue to consider is liver health and anti-HIV medicines. Many
anti-HIV treatments, including the protease inhibitors
and the non-nucleoside reverse transcriptase inhibitors,
are broken down (metabolized) by the liver. This can pose two problems
for people infected with both HIV and HCV. First, the liver needs to be
healthy in order to process these drugs correctly. If HCV damages the
liver, it might not be possible to begin or continue taking life-saving
anti-HIV therapy. Second, some of the drugs used to treat HIV can cause
liver damage, even in people who aren’t infected with HCV. In turn,
some anti-HIV drugs might worsen or speed up the liver disease being caused
by hepatitis C.
People infected with both HIV and HCV need to work very closely with
their healthcare providers. It is important that people infected with
both viruses monitor their health carefully.
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