About 1,000,000 people in the United States have HIV—1 out of 3 of these people also has hepatitis C. With the major improvements in HIV therapy in the last 2 decades, hepatitis C-related illness has emerged as a major health problem for people with both infections.
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Liver-related disease is the #1 cause of death for people with both HIV and hepatitis C. That is why it is important you talk to your doctor about treatment today.
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Previously, there was no approved treatment for hepatitis C in patients who were HIV-positive. However, combination therapy with PEGASYS and COPEGUS® (Ribavirin, USP) recently received approval from the U.S. Food and Drug Administration (FDA) to treat hepatitis C in a group of people with both infections. This approval was based on a major clinical study that found that 4 out of 10 (40%) people with clinically stable HIV, liver disease from hepatitis C, and no previous treatment with interferon responded well to hepatitis C treatment with PEGASYS and COPEGUS.
Your doctor and other members of your healthcare team who treat you for HIV can make recommendations about whether (and when) hepatitis C treatment should begin. Be sure to talk to them about your options and the advantages of hepatitis C treatment for your overall health.
| What should you do? The U.S. Centers for Disease Control and Prevention says:
People who are HIV+ and also have HCV infection should:
- Be given information about prevention of liver damage
- Undergo evaluation for chronic liver disease
- Be considered for treatment (if indicated).
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Why is the liver so important to my health?
- Filters toxins and waste products from your blood
- Manages cholesterol and other chemicals in your body
- Makes protein, bile, and agents that clot your blood
- Helps your body process HIV medicines
- Stores vitamins, minerals, iron, and sugars
- Keeps your hormones at the right level.
You need your liver to stay alive, just as much as you need your heart to keep pumping blood to stay alive.
Why is maintaining a healthy liver so important in successfully treating my HIV?
No doctor can tell you just how fast hepatitis C will damage your liver. But getting treatment earlier, rather than later, may help your liver by stopping the virus from further damaging it.
If hepatitis C causes enough damage to the liver, it may not be possible to start or stay on HIV medication. This is why you may need to treat hepatitis C before there is major liver damage.
As hepatitis C gets worse, it causes liver damage or scarring of the liver, which is called cirrhosis. This can lead to other serious diseases, like liver cancer and liver failure. But there is hope, because hepatitis C treatments are available that may help stop the damage to your liver, which may make it easier to take HIV medications.
How does being HIV+ affect hepatitis C?
HIV can make hepatitis C worse. People with HIV tend to have hepatitis C that gets worse, faster. Some medications that fight HIV can cause more damage to your liver. This is because anti-HIV medicines must pass through the liver. In people with both viruses, anti-HIV drugs may add to the damage caused by hepatitis C.
Without hepatitis C medication, people with HIV may progress to end-stage liver disease, which means they may need a liver transplant. They also could get liver cancer or may even die from untreated hepatitis C.
How does having hepatitis C affect HIV infection?
Hepatitis C does not seem to make HIV worse. But the liver damage from hepatitis C may make it harder for your liver to process HIV drugs.
What can happen if hepatitis C is not treated?
If the damage continues, scar tissue starts to replace normal liver cells. Once a liver has scar tissue, it cannot heal itself completely. The more scar tissue there is, the harder it is for the liver to do its many jobs. For you, this may include processing your HIV medications.
Why it is important you talk to your doctor about treatment today:
- Liver-related disease is the #1 cause of death in coinfected patients.
- Liver disease progresses fast, and you cannot predict how fast your liver disease will advance.
- On average, it can take approximately 7 years for some people’s livers to develop advanced scarring.
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How are the treatment goals for hepatitis C medication different from HIV medication?
The main goal of treatment for both HIV and hepatitis C is to reach undetectable levels of virus. While you will take your HIV medications for life, treatment for hepatitis C is only for a short period of time (48 weeks). If hepatitis C treatment is successful, you achieve a sustained virologic response (SVR). SVR means that you have no detectable levels of hepatitis C virus in your blood at the end of treatment and again 6 months later. Another important goal is to stop more liver damage from occurring. The best way to try to do this is to take all medicines just the way your doctor tells you to.
What HIV medications should you avoid when you are on hepatitis C medication?
You should not take didanosine with COPEGUS. Talk to your doctor about other medications you can take instead.
Your doctor will watch you to make sure you are not having problems taking other HIV drugs with PEGASYS and COPEGUS.
What should I ask my doctor about treatment?
Hepatitis C medication is available for people with HIV. If you have chronic hepatitis C, ask your doctor about treatment. Find out if there is any medical reason why you cannot try hepatitis C medication . Also, let your doctor know if you have any worries about taking medication for hepatitis C.
What effect do PEGASYS and COPEGUS have on CD4+ cell counts?
As a person with HIV, you are probably well aware of your CD4+ cell count and understand how important it is to keep it as high as possible. You may even use it as a measure of your HIV control.
In studies, the CD4+ cell counts of some patients with HIV taking PEGASYS and COPEGUS went down. But after treatment ended, they went back up to the levels they were before they started taking these medications. Your doctor will continue to monitor your CD4+ cell counts during therapy.
How does taking PEGASYS and COPEGUS affect my HIV?
Studies have shown that PEGASYS and COPEGUS do not affect HIV viral load. When patients were given these medications, their average HIV viral loads did not go up during treatment.
How long do I take PEGASYS and COPEGUS?
You should follow your doctor's instructions. The recommended time period for treatment is 48 weeks, no matter what genotype of hepatitis C you have.
What dose of PEGASYS do I use?
You should follow your doctor's instructions. The recommended dose is 180 mcg once a week. If you are having a problem, your doctor might reduce the dose for a while to either 135 mcg or 90 mcg. Both of these doses are marked on the prefilled syringe.
What dose of COPEGUS do I use?
You should follow your doctor's instructions. The recommended dose is 800 mg each day. Again, if there is a problem, your doctor might reduce the dose. Always follow your doctor's instructions.
What are the possible side effects of treatment?
Side effects of treatment with PEGASYS and COPEGUS were similar for people with and without HIV. Want to know about side effects?
A few side effects were more common in people with HIV, including anemia, other blood disorders (neutropenia and thrombocytopenia), weight decrease, and mood alteration.
