Co-infection with HIV

Increasingly in Canada, people who have HCV are also infected with HIV. People living with both HIV and HCV face significantly increased health challenges. These challenges are not impossible to overcome, but do require that people have access to knowledgeable healthcare and information in order to manage their dual conditions and live long and healthy lives. For more information on HIV, visit CATIE’s website at www.catie.ca. Here’s a quick overview:

What is HIV?

HIV stands for Human Immunodeficiency Virus. It is a virus that attacks a person’s immune system and causes AIDS. AIDS stands for Acquired Immune Deficiency Syndrome.

How is HIV transmitted?

HIV is carried in five body fluids: blood, semen, vaginal fluids, rectal fluids and breast milk. A person can be infected with HIV when one of these fluids gets into the body. This usually happens in the following ways:

• through unprotected sex (usually anal or vaginal sex)
• by reusing drug use equipment already used by someone else
• mother-to-child transmission during childbirth or breastfeeding, if the mother has HIV
• from a blood transfusion in Canada before 1985

HIV enters the body in many of the same ways as Hep C and hepatitis B, so people can take the same steps to protect themselves from Hep C, hepatitis B and HIV. (See the section on Harm Reduction for more information.)

What is CD4+?

CD4+ refers to a kind of white blood cell that is part of the immune system. Like other parts of the immune system, CD4+ cells help to keep people healthy. They protect the body by coordinating other parts of the immune system to attack viruses, bacteria and other invaders that may cause illness.

What does HIV do?

HIV gets into a CD4+ cell and uses it to make more viruses (called replication). This causes the CD4+ cell’s functioning to be impaired and the cell eventually dies. When there are fewer CD4+ cells, it is easier for other viral or bacterial infections to set in and make a person sick. CD4+ cell count is an important measure of how well the immune system is functioning. A good immune system generally has a CD4+ count greater that 500 but this can vary from person to person.

HIV viral load is also an important measure of HIV disease. The more HIV present in the body, the more the virus attacks the immune system and the greater the chance of getting sick.

HIV is a virus that attacks a person’s immune system and causes AIDS.

Over time, when HIV has killed many CD4+ cells, the immune system will not work as well. A person is then susceptible to illnesses that a healthy immune system could easily control. These are called AIDS-defining illnesses or opportunistic infections and include some types of pneumonia (like PCP) and some cancers (like Kaposi’s sarcoma). In Canada, a person is considered to have AIDS if he or she is has HIV and gets sick with one or more of these diseases.

When someone has HIV, it is important to have regular checkups with a doctor to monitor HIV viral load and CD4+ count because these will guide decisions around starting or changing treatment.

HIV Treatment

There is no cure for HIV, but there are medicines that fight HIV. HIV medicines are called Highly Active Antiretroviral Therapy (HAART) and involve taking three or more drugs at the same time.

These medicines can reduce the HIV viral load in blood and semen to undetectable levels. Most HIV viral load tests can only detect more than 50 copies/ml and cannot measure below this threshold. HIV is still in the body and researchers are not yet sure if transmission can still occur. However, when the virus is undetectable it is prevented from killing off CD4+ cells, and the body can replenish the CD4+ cells that have already died to a level that will protect a person from getting sick.

HIV is tricky and can mutate, which means its genetic makeup changes. This leads to “drug resistance” where a person’s drug combination will not work to stop HIV from replicating. Drug resistance happens especially if a person does not take his or her medicines regularly. But because there are more than 20 different anti-HIV drugs, and different combinations of these drugs, people have many treatment options and they can live long and healthy lives with HIV.

Visit www.catie.ca to find out more about HIV or HIV treatment.

Co-infection with HIV

Approximately 10,000 people in Canada are co-infected with the human immunodeficiency virus (HIV) and the hepatitis C virus (HCV). Although these numbers are based on estimates and predictions, it does mean that about 20% of people living with HIV are also living with Hep C. This combination can be dangerous and cause more complications for each disease. Currently, liver disease related to Hep C is the leading cause of death among people with HCV-HIV co-infection.

Co-infection Complications

Each disease makes the other more complicated. Research shows that people with both infections are likely to develop cirrhosis more quickly and may be at a greater risk for heart disease. Treatment decisions for both viruses are more challenging as people who are co-infected may respond differently to medications used to treat HIV or Hep C. (See Treatment for HIV and Hepatitis C for more information.) Therefore, all of the suggestions for reducing harm and maintaining health are even more important for people who have both infections. (See Harm Reduction for more information.)

Testing

Screening for Hep C is recommended for all people diagnosed with HIV, and vice versa. Keep in mind that having advanced, untreated HIV can sometimes lead to false negative results in Hep C antibody tests because the immune suppression caused by HIV reduces the body’s ability to manufacture antibodies. More tests may be required to get the full understanding of the status of HCV in the body.

Transmission: Similarities

Although separate and distinct viruses, HIV and HCV do share some similarities. Both viruses can be transmitted by blood-to-blood contact. Sharing materials contaminated with blood (including equipment for injection drug use, piercing, tattooing or medical procedures including blood transfusions) puts a person at risk for both viruses.

Transmission: Differences

HIV and HCV also have their differences. For example, bleach does not kill HCV but has been effective in reducing HIV transmission when used to clean drug-use equipment. Also, HIV is a fragile virus that does not survive long outside of the body, where HCV may survive for longer. Although both viruses are transmitted through blood-to-blood contact, HIV is transmitted more frequently through sex and childbirth than HCV.

Transmission: Interactions

Having HIV increases the chances of transmitting HCV through two routes: during childbirth and during unprotected sexual intercourse. A baby born to a mother co-infected with HIV and HCV is more likely to be infected with HCV than if the baby’s mother is infected only with HCV. The risk of sexual transmission of HCV is low but can greatly increase with the presence of sexually transmitted infections, HIV, menstruation or through certain sex practices, including rough sex, fisting, group sex or sex with multiple partners.