hiv ribbon(BlackDoctor.org) — Following up from our last article on hepatitis B infection in HIV disease, we will now discuss another one of HIV’s party companions, Hepatitis C.  In the last article, I introduced HIV as a “party virus” to convey the point that other infections commonly occur along with HIV infection.

Many of these other infections, such as the hepatitis viruses, herpes, and human papilloma virus, are also sexually transmitted or transmitted by sharing needles for intravenous drug use.  Recall that there are several different hepatitis viruses, but they are not related at all.

The only thing they have in common is that they attack the liver, but they are structurally different, infect liver cells and reproduce differently and even damage the liver by different methods.  Hepatitis C (HCV) is mainly transmitted by intravenous drug use, when infected needles are shared, while about 10% of individuals are infected through sexual intercourse with an infected person.

However, among gay men, there is a growing epidemic of HCV infection among individuals who do not use intravenous drugs. It appears that anal intercourse without the protection of a condom can increase the risk of sexual transmission of HCV.  It can be transmitted from a pregnant mother to her infant. Overall, in the US, about 30% of HIV patients also have HCV infection (perhaps 300,000 people).  However, in clinics where I have worked in Washington DC and Baltimore, as many as 50% of patients have both HCV and HIV infection. A small percentage have HIV and both HBV and HCV.  Much of this disease stems from heroin use.

About 15% of people infected with HCV can eliminate the infection by their own immune system. The other 85% or so develop a chronic infection that is around for life.  Chronic HCV infection may not present with symptoms, however, soon after infection, some people will experience certain symptoms and signs such as nausea, vomiting, diarrhea, loss of appetite, fatigue, dark-colored urine, grayish-colored stools.  The skin and the whites of the eyes (the sclera) may appear yellowish.  These symptoms do not linger and may soon go away.  The patient may have increased levels of liver enzymes in the blood, which indicate that liver damage is occurring, but these levels can fluctuate.  The best test to diagnose this infection is the test for the presence of HCV antibodies in the blood.

In a previous article, I described the dangers of HBV infection and HCV infection causes the same risks.  Our biggest concerns are that HCV can cause cirrhosis of the liver, which is a serious, life-threatening condition by itself.  It may take 20 years or more for HCV infection to progress to cirrhosis but having HIV infection can accelerate this process. Even worse, liver cirrhosis often can progress to liver cancer, which has no effective treatments.  African-Americans have 5 year survival rates for liver cancer almost half those of whites, which are only about 5%, but this varies from study to study.