Have HIV? Get Hip to Hep C

A discussion about the risk of transmitting or contracting HIV without mentioning Hepatitis C is like talking about Clyde Barrow without Bonnie Parker. Separately, they were a delinquent and a bored young woman. Together they were killers.

Hepatitis C, or Non A Non B Hepatitis as it was formerly known, is an infectious disease affecting mainly the liver. What makes it worse is that the infection is often asymptomatic. So you may not even know you have it until you suffer the debilitating effects of chronic infection.

Over time, Hep C will scar the liver and eventually lead to cirrhosis, which is usually only apparent after many years. In some cases, those with cirrhosis will go on to develop liver cancer and liver failure. When cirrhosis sets in, a person with HCV has a limited number of days left. A liver transplant is often needed for the patient to live.

HCV is transmitted through the exchange of infected blood and other body fluids. Saliva does not carry the HCV virus. Most infected people contract it through unprotected sex, or the sharing of needles and other injection equipment. Blood-to-blood contact, however, is the most common form of transmission. This does not necessarily mean that a person has to share a needle with an infected person to get it.

Any activity that results in bleeding (internal or external) can put a person at risk for HCV infection. If the sex is rough enough, tissues are torn, giving an entryway. HCV is present in semen and vaginal secretions, but are not as likely to result in infection as that of blood-to-blood contact. That said, there have been reported cases in which infected blood was transferred from the semen of someone with testicular cancer.

Unlike HIV, HCV remains alive and infective outside of the body for weeks. That's why dried blood from an infected person or an open sore or wound can be dangerous. Even something as seemingly innocent as sharing toiletries like shaving equipment, manicure utensils and toothbrushes pose a threat; dried blood is often present and can enter the blood stream through a cut or abrasion.

The elusiveness of HCV makes it particularly insidious. Since a person can remain asymptomatic for years, early detection is especially important. The Centers for Disease Control estimates that 3.2 million Americans are infected - nearly three-quarters of whom don't even know it. Symptoms include the familiar ones common to all hepatitis: jaundice, fatigue, joint pain, dark urine, pale colored stools, itchy skin and stomach pain and bloating. When these symptoms arise, the infected person may already be well on the way to liver failure.

Drug companies have responded to the numbers with hundreds of new meds in the past 10 years. Many of these drugs aren't cures; at best, they only hold the virus at bay. Some treatments have eradicated the virus entirely. Combining interferon and ribavirin has been especially effective, with an 80 percent cure rate.

Co-Infection With HIV Makes It Worse

Here's the bad part, and it's real bad: Those co-infected with HIV don't fare as well. The road to recovery is rougher.

HCV/HIV co-infection comes with it's own set of problems and pitfalls. Unfortunately, HCV often comes with HIV infection, since they both share the same modes of transmission. The success of antiretroviral medications in recent decades has enabled those with HIV to live long enough to manifest HCV.

So what should you do? Get tested! Of those living with HIV, almost a third is believed to also be infected with HCV. The only way to know if you're infected is to have your doctor test you regularly.

There are treatments available to prolong your life expectancy and better your quality of life. Currently, the Food and Drug Administration has approved only one treatment for HCV/HIV co-infection. It appears to have dropped HCV to undetectable levels in nearly 70 percent of recipients over 48 weeks.

The problem facing providers is the interaction of interferon and protease inhibitors, which are almost always present in HIV meds. Severe reactions including extreme intestinal distress, loss of memory, decreased motor skills and even death were reported in initial trials.

In most cases, treating an HIV/HCV co-infected patient requires the HIV to be under control (undetectable and high Cd4 count) for an extended period of time before adding an HCV regimen. Usually, the HIV drug regimen has to be altered; often, that means taking out protease inhibitors. This can be a headache for your doctor to figure out, and can be scary for you.

"Side effects from the present protease inhibitors are really tough," Dr. Douglas Dietrich, a liver specialist at New York's Mount Sinai Hospital, told an interviewer earlier this year. "What we're all waiting for are interferon-free combinations, which will be available in mid-2014, a fixed-dose combination pill to be used with ribavirin, and a four- or five-drug combination, which will require some thought in terms of HIV drug-drug interactions." Early trials have been highly successful.

Best of all is to make sure, if you aren't infected with HCV, that you stay that way. Sorry, but once again, your only sure defense is using condoms. "Until recently, I didn't know the risk of getting Hep C from bareback sex," Victor, a 38-year-old HIV-positive bartender in New York, told EDGE. "My doctor never mentioned it, never tested. I tested positive for Hep C in August. I've probably had it for years. I changed doctors."

Victor listened to those who said that serosorting partners enabled him to throw away condoms. Now, he has regrets, not only for himself, but for those with whom he had sex. "Thinking it was safe, he said, "I've only been having bareback sex with other HIV-positive guys.

"How many of them did I give it to?"

This story is part of our special report: "Ask the Doc: Special HIV Edition". Want to read more? Here's the full list.

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