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national news
Hepatitis C and HIV
Those who carry both viruses await answers as to their
reciprocal effects and the impact of HIV drugs on liver disease
▼
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by Bob R oehr
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4 1 1 7 SE Division St.
(Located in Richmond Place)
STEREO
S P R I N G
CLE ANI NG
2627 nor t h e a s t
B R O A D W A Y
S T E R E O T Y P E S
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oes infection with both HIV and hepa­
Thomas cited data indicating that people in­
titis C virus (known as HCV) result in
fected with both HIV and HCV have a more rapid
a synergy that causes one or both
progression to liver disease. He called the re­
diseases to progress more rapidly? Is
verse—the suggestion that HCV infection pro­
motes HIV progression—a “murky area” with
there a possibility that anti-HIV medi­
cations metabolized in the liver might cause
HCV
little
supporting evidence.
disease to progress more rapidly?
Howard Grossman, a physician in Manhattan
A National Institutes of Health Consensus
with a large HIV practice of gay men, tests “ev­
Development Conference on the management of erybody who comes through the door” for hepa­
hepatitis C answered neither of those questions.
titis A, B and C. He hasn’t found many cases of
The three-day meeting at the NIH campus, which
HCV and notes that the rate of HBV infection has
concluded March 23, called for research on the
declined from earlier in the epidemic. “If they
first question but did not even raise the second.
haven’t been exposed,” he says, “we vaccinate
That troubles AIDS researchers and treatment
[for A and B].” But he does not believe that
activists.
practice is standard care for most physicians, in
Hepatitis C virus, which can cause chronic
part because “we have to fight the managed care
liver infection, was isolated and identified only in
companies to do that.”
1989. An estimated 4 million people in the United
“Clearly any active infection causes HIV to
States are infected with HCV, four times as many
replicate faster,” says Grossman. He notes that
as have HI V. It has become the leading reason for
people with an underlying liver infection “tend to
liver transplants in the coun­
be somewhat harder to treat,”
try. Screening of the blood
but he says he has seen no
supply since 1990 has greatly
clear evidence that they
reduced the annual number
progress more quickly with
of new infections. Still, about
their HIV disease.
8,000 people each year die
Brenda Lein, of Project
from HCV-related illness, and
Inform in San Francisco, en­
the number may well triple
courages people with dual
within 20 years.
infection “to pay more atten­
HCV shares many simi­
tion to their liver enzymes.”
larities with HIV. Both can
She calls it “a cautionary
have long periods between in­
note” and “not a reason to
fection and the onset of clini­
not treat, one way or the
cal symptoms, so people may
other.”
not know they carry the virus.
Grossm an points to
The viruses are spread simi­
"some indication that there
larly—through blood prod­
may be some benefit from
ucts, sharing needles, sexual contact and failure of
3TC” for patients who are co-infected with hepa­
universal medical precautions—though HCV ap­
titis B virus. He has also used interferon to treat
pears to be more difficult to transmit sexually.
hepatitis and seen residual positive effect on the
Hepatitis C virus is found in 80 percent of
HIV as well.
people withHIV who have ever injected drugs, 10
Conference chairman D.W. Powell, of the
to 15 percent of HIV-positive heterosexuals who
University of Texas Medical Branch at Galveston,
have not injected drugs, and only 2 percent of called for “developing] protease inhibitors for
HIV-positive homosexuals who have not injected
hepatitis C.”
drugs. David L. Thomas, a hepatitis researcher at
The conference draft report also stated: “While
Johns Hopkins University, finds an explanation
alcohol ingestion clearly worsens the course of
in two factors. One is that HCV is not as effi­
hepatitis C, the reasons for this interaction are
ciently transmitted through sex as is HIV, the
unknown.” One hypothesis is that alcohol re­
other is that “the reservoir of infection is lower” duces liver functions which hold HCV in check,
among gay men, so that they are less likely to meet
allowing the infection to progress more rapidly.
someone with HCV. However that is no reason to
Which raises the question of whether pharma­
be complacent, as there are likely pockets or
ceuticals that depress certain liver functions may
clusters of gay men among whom the rate of HCV
also promote a more rapid progression of HCV.
infection is high.
Many anti-HIV drugs are metabolized in the liver
HCV infection is underdiagnosed because of
and can depress that organ’s capacity to function,
physician ignorance, the limited accuracy of tests
sometimes to the point of its failure. So it is logical
for HCV, and the slow progression of the disease.
to speculate as to whether certain anti-HIV thera­
Both viruses are highly unstable, that is they
pies may promote HCV-related liver disease in
mutate easily, so it is difficult to fashion vaccines
people who are infected with both viruses.
and therapy. The most successful treatment to
The answer is, we don’t know.
date for HCV has been interferon alpha, adminis­
Spencer Cox, of the Treatment Action Group
tered, sometimes with the antiviral drug ribavirin,
in New York, says that anti-HIV medications
for a 12-month period. But the rate of success, as
have been tested in “people with decreased liver
measured by clearance of the virus and non­
functions. And predictably there has been a slightly
recurrence when therapy is stopped, has never
higher risk of liver enzyme elevations requiring
climbed above 20 percent.
discontinuation of therapy.” He voices concern
Miriam J. Alter is chief of the epidemiology
that the trials have been very small and aimed at
section of the hepatitis branch of the Centers for
demonstrating immediate, highly toxic reactions.
Disease Control. She says that it is not unusual for
They have not measured long-term effects such as
individuals to become infected with a combina­ a chronic hepatitis.
tion of hepatitis B virus (HBV), HCV and HIV,
As protease inhibitors and other therapies ex­
because they are transmitted or acquired in much
tend the life expectancy of people infected with
the same way. The rates of infection are highest
HIV, medical problems such as hepatitis C that
for HCV, she says, and it “appears to be acquired
develop more slowly are likely to emerge as
first, before either HBV or HIV.”
significant health problems.
D