Spotlight Series on Hepatitis C

Hepatitis C Virus: Infection, Prevention and Treatment

December 23, 2010

In high-income countries today, hepatitis C virus (HCV) is most commonly spread through sharing equipment for substance use, such as needles and straws. Exposure to unsterilized tattooing needles can be another source of infection. HCV can also be transmitted among HIV-positive men who have unprotected anal sex. Presumably this can also occur among HIV-positive women who have unprotected anal sex.

HCV infects the liver and may initially cause mild flu-like symptoms, so people infected with HCV may not be aware that they have it. If HCV infection persists, the liver slowly degrades over many years. Among people co-infected with HIV and HCV, accelerated liver damage can occur.

If left untreated, HCV infection can cause severe liver damage, eventually leading to painful complications and liver failure. In some cases, liver cancer and death are also consequences of prolonged HCV infection. Therefore, testing for HCV infection, consistently practicing safer sex, not sharing equipment for drug use and getting psychosocial support for recovering from addiction and other mental health issues are steps that can lead to better overall health.

The standard therapy for HCV infection is a combination of long-lasting interferon (peginterferon) taken once weekly and another drug called ribavirin, which is taken twice daily. People with acute (very recent) HCV infection can sometimes benefit from relatively short courses of HCV therapy (24 weeks) and clear HCV. But for people who have been HCV positive for longer or who are co-infected, treatment with peginterferon and ribavirin usually lasts for 48 weeks.

HCV can be divided into subtypes, or strains, called genotypes. Infection with genotypes 1 and 4 are more difficult to treat than genotypes 2 and 3. In high-income countries, genotype 1 is commonly found.

In cases of HCV mono-infection, treatment can result in about 50% of people clearing HCV. However, among people with both HIV and HCV, recovery rates are not as high.

Peginterferon can cause temporary side effects with symptoms such as those related to having the flu. Other side effects that can also occur while people are undergoing treatment with peginterferon include reduced numbers of red blood cells, irritability and depression. Therefore, new, safer and more effective therapies are needed.

New anti-HCV drugs are being tested in several phases in many clinical trials. In this issue of TreatmentUpdate, we present information on some of these promising compounds.

This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication TreatmentUpdate. Visit CATIE's Web site to find out more about their activities, publications and services.

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