Question
What medications work best for HIV and hepatitis C coinfection?
20 September 2010. Related: Access to treatment, All topics, Complications and coinfections, Starting treatment.
I have HIV and HCV, what medications work best to fight both infections at the same time without liver damage? I had a liver biopsy and it’s stage 2.
Answer
Thank you for your question.
Unfortunately, there are no medications that work on both HIV and hepatitis C (HCV). Which treatment you start first depends on your CD4 count. For more information please follow this link.
HCV treatment is with a combination of two medications, pegylated interferon and ribavarin. Treatment is usually recommended for at least a year. For more information please follow this link.
There is now a genetic test you can do to find out whether it is likely that the HCV treatment will be effective against the virus. For more information please follow this link.
For some general information about HIV and HCV co-infections please follow this link to the i-base guide to ‘Hepatitis C for people living with HIV‘
For information about new HCV treatments in the pipeline please follow this link.
As for HIV treatment, there are a lot of very good drugs available at the moment. Most people start with a combination of 2NRTIs (nukes) and either 1NNRTI (non-nuke) or a boosted protease inhibitor (PI). For a complete list of HIV treatments please follow this link.
For an overview of HIV treatments please follow this link to the ‘Introduction to Combination Therapy‘ guidebook.
As far as liver damage is concerned, different biopsy tests have different numbered results. For more information about what your results mean please follow this link.
If you have some mild liver damage then you will be very closely monitored by your HIV doctor and by a liver specialist. The HIV treatments you will be given will be chosen specifically with yourliver function in mind. The dosage of HIV treatments will also be tested and monitored to ensure that the liver is well looked after and not overworked. This way it is possible for someone with mild liver damage to never have a severely damaged liver.
Most HIV treatments are filtered by the liver and so could potentially affect liver function. If you are aware you have liver problems then there are some medications they should try to avoid. These include nevirapine, ritonavir, tipranavir and possibly also efavirenz as studies have shown similarities between nevirapine and efavirenz in terms of liver toxicity.
There are certain lifestyle changes that could help you to maintain your liver such as
- Getting hepatitis A and hepatitis B vaccines. Having another viral infection in your liver can worsen hepatitis C.
- Drinking less, or stoping drinking alcohol—the less you drink, the better for your liver.
- Maintaining normal weight. Being overweight increases your risk for fatty liver.
- Drinking plenty of water, to help your liver filter out waste and toxins.
- Eating fewer fatty, salty and high sugar foods.
- Trying to eat more fresh fruit and vegetables, complex carbohydrates (whole grains, breads, rice, pasta, cereals, vegetables, fruits, beans, nuts and seeds), low-fat foods, high-fibre foods and an adequate amount of protein.
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