Author: Neighborhood Reporter
Author Date: 1/27/2003

Boston researchers have confirmed that people co-infected with both
hepatitis C and HIV, the virus that causes AIDS, may not be suitable
candidates for HCV therapy with interferon and ribavirin.(1)

"The impetus for this study was the realization that many of the
patients we were seeing in our co-infection clinic were not
candidates for interferon based therapy despite the increasing
access to and benefits of treatment," said Catherine Fleming, M.D.,
of Boston Medical Center, and the study's lead investigator, in an
interview with Priority Healthcare.

Treatment Barriers

The key barriers to treatment for this group of patients-large
minorities who live in urban areas-are missed clinic visits, active
psychiatric illness, drug and alcohol use, liver disease, or other
medical illnesses, the researchers conclude.

In the study, Fleming and her colleagues evaluated 180 HCV/HIV co-
infected patients to determine whether they were candidates for
therapy.

Of the 149 patients who completed the evaluation, they found that
only 30 percent were eligible. Of those, just over a third began
interferon therapy during the course of the study.

Fleming said that this urban population possesses a range of medical
and social issues that prevents its members from being candidates
for interferon therapy. Overcoming this challenge will require a
multidisciplinary approach and earlier medical evaluations of these
patients, Fleming said.

Of those found unsuitable for treatment, about a fourth failed to
visit their physician regularly, 21 percent had active psychiatric
disease, a fourth had abused drugs or alcohol in the previous six
months, 12 percent had liver disease, 13 percent were infected with
advanced HIV disease, and the remaining patients had other diseases
or conditions that were contraindicated in interferon therapy.

"I think that this is a very complex patient population, and that
there is no single solution," Fleming told Priority
Healthcare. "However, earlier evaluation of hepatitis C in co-
infected patients, access to methadone programs with directly
observed therapy, and psychiatry support would all help."

Patient education may also be the key, helping patients who face
such challenges to realize the consequences of drug and alcohol
abuse, Fleming pointed out.

Prevalence of Co-Infection

It is estimated that more than 500,000 adults in the United States
are either infected with HIV, or are living with AIDS.(2)
Approximately one-fourth those are also infected with the hepatitis
C virus. HCV infection typically progresses more rapidly to liver
damage in HIV-infected people, and may impact the course and
management of HIV.(3)

There are several preventative measures that people living with HIV
can take to prevent becoming co-infected with hepatitis C, including
not injecting or stopping injection drug use, not sharing personal
items like toothbrushes and razors that may be contaminated with
blood, and avoiding at-risk behaviors like tattooing and body
piercing.(3)