July 28th is World Hepatitis Day, which aims to raise awareness of viral hepatitis around the world. There are five main types of hepatitis virus, referred to as types A, B, C, D and E. Hepatitis C is considered to be causing a “dual epidemic” with HIV because it is highly prevalent in HIV-endemic areas. About five million people living with HIV, or 15% of the total, are co-infected with hepatitis C. It disproportionately affects vulnerable populations that also have a high risk of developing HIV infections, especially in Africa, Asia and Eastern Europe.
Hepatitis C and HIV treatment in developed countries
The release of two new hepatitis C drugs - Sofosbuvir and Simeprevir – this year has enabled 90 percent of treatments to be successful within 12 - 24 weeks in developed countries. These new drugs are also very effective at treating HIV, in contradiction to the old hepatitis treatment regimes that had low success rates in people living with HIV.
Treatment of hepatitis C and HIV in developing countries
Hepatitis C can be completely cured, although effective hepatitis C treatments are often inaccessible in low- and middle-income countries due to the high costs of these treatments. Hepatitis C, which causes a destruction of the liver, progresses faster in people living with HIV than other people, caused by their weakened immune systems. If hepatitis C is untreated it could result in a life threatening liver cirrhosis. The main worry regarding HIV and Hepatitis C co-infections is the uncertainty that the antiretroviral drugs used in HIV treatments may affect a person's liver and worsen a hepatitis C infection. Doctors therefore used to treat people living with a co-infection differently from those who only had hepatitis C.
Promisingly, a new study published in " Science Translational Medicine” concludes that antiretroviral drugs used in HIV treatment can have a direct effect on the hepatitis C virus. The study, including 17 patients co-infected with HIV and Hepatitis C receiving antiretroviral drug therapy, found that the hepatitis C viral load in their blood dropped, implying that the antiretroviral drug seemed to stop the virus from multiplying. The explanation is that antiretroviral drugs decrease liver inflammation and reduce the hepatitis C virus load.
Although the most effective hepatitis C drugs might not yet be available in low- and middle-income countries, early antiretroviral treatment of people living with HIV and hepatitis C co-infection is important in the fight against Hepatitis C.