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HCV/HIV Co-infection—A Patient’s
Perspective
by Gerald Moreno
I remember sitting
in my doctor’s office one day in 1996, feeling great and full
of hope. This wasn’t the kind of hope that I had been feeling
for the last 12 years, but hope that I could actually grab
onto instead of visualize. The protease inhibitors were recently
approved by the FDA, and I was seeing the dramatic effects
they were having on the HIV community, as well as on myself.
My doctor asked how I was feeling, and I answered him with
a confident “GREAT!” Then he gave me my latest lab results.
My T-cells were responding and my viral load was down for
the first time in 12 years. I was elated. He then informed
me that one lab marker concerned him. This was a marker that
measured enzymes produced by the liver.
The liver is an important
organ that cleans the blood, makes proteins for muscles, stores
energy, helps digestion, boosts the immune system, and is
necessary for life. We should all have low levels of liver
enzymes in our blood; elevated enzymes may indicate liver
injury.
The two most common liver
enzymes studied are ALT (SGPT) and AST (SGOT). Mine were elevated.
After an extensive history, more lab work was ordered. Two
of the tests ordered were a hepatitis C (HCV) antibody test
and an HCV viral load (similar to HIV). A week later I received
the news. My antibody test came back positive, which meant
that I had been exposed to the hepatitis C virus. My viral
load came back as greater than 1000, which meant that I had
chronic hepatitis C.
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Learn everything that
you can because knowledge does equal power. Make the effort
to explore the options available to you.
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Approximately 85% of people
who have been exposed to HCV develop chronic infection. Chronic
infection means that the body is not able to rid itself of
the virus and is continually trying to fight it. It also means
that HCV positive individuals can pass on the infection to
someone else through a transmission route, predominantly blood-to-blood
contact with HCV. I remember asking my doctor what all of
this meant. He answered solemnly that hepatitis C is a very
serious disease and could be potentially fatal. I recalled
familiar memories of receiving another diagnosis…HIV. After
a time of self-pity and depression, I called upon the survivor
skills that I had learned from HIV: Learn everything that
you can because knowledge does equal power. Make the effort
to explore the options available to you.
What I learned was that hepatitis
C (HCV) is a viral illness that affects the liver. The estimated
prevalence of HCV worldwide is approximately 170 million,
3.9 million in the U.S., and 500,000 in California. In 1990
an antibody was identified. Before that, HCV was known as
“non-A, non-B hepatitis.” The HCV has six genotypes, all with
subtypes. A genotype is the specific genetic makeup or “blueprint”
of an organism, in this case a virus. Genotype 1 is the most
common in the U.S., and is unfortunately the most difficult
to treat.
HCV is spread primarily by
blood-to-blood contact. Upon learning this, I immediately
realized my risk factor. I had been an injection drug abuser,
who shared works with people I didn’t even know. Other methods
of transmission are blood transfusion products, tattooing,
body piercing, snorting drugs, multiple sex partners involving
contact with bodily fluids, and hemodialysis. The progression
of HCV from the acute phase (first six months of infection)
to experiencing symptoms is on average 20 years. For persons
co-infected with HIV, this time is shortened to 10 to 15 years.
Not everyone experiences symptoms, but those who do may notice
fatigue, poor appetite, abdominal and muscle pain, itching,
dark urine, and jaundice (yellowing of the skin and eyes).
With this information in
hand, I decided to seek out a doctor who specialized in both
HCV and HIV (another lesson learned from HIV). He ran a few
more sophisticated tests and wanted to know all the supplements
and medications I was taking. Everything we ingest is filtered
through the liver, and many vitamins and minerals are toxic
to the liver. Now I never take supplements without informing
my physician first, especially because I am on HAART.
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My mission statement
in life is empowerment:
Empowerment to live, empowerment to grow, and above all,
empowerment to give back.
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Highly Active Anti-viral Treatment
(HAART) regimens usually include protease inhibitors (PIs),
which undergo extensive hepatic metabolism. This means the
medications are processed through the liver. The possibility
of liver complications exists for all six of the currently
available PIs, especially Norvir and Crixivan. This is why
it is imperative to work with a specialist, so that he/she
can sort out whether toxicity, if any, is due to medications,
to supplements, or to the virus itself. The toxicity that
I experienced was indeed due to my HAART regimen, but my specialist
recommended that I stay on this combination and be monitored
monthly because the toxicity was not very high.
Because I am aggressive about
my health, I asked for a liver biopsy. A liver biopsy is a
tiny sample taken from the liver (it doesn’t hurt) and examined
under a microscope. Scientists can see the level of liver
damage and make correct diagnoses and suggestions for treatment.
The results from my biopsy showed minor inflammation, no scarring
or cirrhosis (fibrous tissue, a response to trauma), and no
treatment was recommended.
As with HIV, there is great
momentum in the development of HCV treatment. Today we have
combination therapy with interferon with ribavirin, and in
the near future we will have pegylated interferon (a time-released
interferon) and pegylated interferon and ribavirin. The response
rate to HCV treatment with pegylated interferon and ribavirin
in [very small, early] clinical trials is approximately 40%
for genotype 1, and 80% for genotypes 2 and 3.
I believe that everybody,
with the help of a support team, can find a program that works.
Since being co-infected can make HCV or HIV worse, I monitor
myself and see my doctor every two months. I am encouraged
by the advances we have made and see a bright future. I take
care of myself the best that I can, one day at a time, so
that I can take advantage of what the future will have to
offer. This means that I eat good, healthy food; exercise
regularly; and get plenty of rest. I drink lots of water,
no caffeine, and definitely no alcohol. (If you want to do
one great thing for your liver, stop all alcohol consumption
and replace it with water!) As with HIV, living with co-infection
has many challenges that may warrant a lifestyle change. I
just celebrated 10 years of sobriety/recovery, and if I can
meet that challenge, anyone can. My mission statement in life
is empowerment: Empowerment to live, empowerment to grow,
and above all, empowerment to give back.
Gerald Moreno is a screening coordinator
and health educator at the University of California-San Diego
Treatment Center. UCSD is a research facility and is currently
conducting clinical trials for co-infected individuals (people
who are living with HIV and HCV), and some of these studies
include pegylated interferon. For more information, contact
Gerald Moreno at 619-543-8080 ext. 237.
Editor’s note: Thanks to Gerald
Moreno for sharing his story and this information, and to
James Learned at CRIA for his review and comments on this
article.
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