(damage to the liver short of cirrhosis) can be improved by HIV treatment alone.
In one German study,14 co-infected people on HIV drugs survived for over
seven and a half years while those not on therapy survived for just over four.
treatment for hepatitis C is a weekly injection of pegylated interferon and a
twice-daily oral dose of ribavirin, a drug that amplifies the effect of
interferon. According to whether people have HIV and what kind of hepatitis C
they have, you have to take this for six to eleven, or even 16, months.
decided not to take treatment. “I’m fit, don’t smoke or drink and put myself on
a detox diet. I thought, ‘If there’s a chance anyone can clear this by
themselves, I’m the man’.” He didn’t, though.
“My impression was
that I could afford to wait for treatment because there new drugs in the
pipeline coming along quite imminently. I had also just started a new job and
had heard nothing but horror stories about the side-effects of treatment.”
“However I talked
to the hepatologist [liver specialist], and he explained several things. Firstly,
new treatments for hepatitis C are not
imminent; secondly, even when they do turn up they will initially replace the
ribavirin, but not the interferon; and thirdly, the earlier you get treated,
the greater the chance of clearing the virus.” He decided to start treatment and
at the time we talked was still taking it.
Hepatologists are cautious
about talking about a ‘cure’ for hepatitis C, so they use the term ‘sustained viral
response’ (SVR). This means that there is no detectable hepatitis C in your
body six months after the end of treatment. In HIV-negative people who take
treatment soon after infection (and excluding those who clear the virus
spontaneously), 95% of people can expect to achieve an SVR,3
regardless of viral genotype. HIV-positive people have lower success rates.
Janice Main achieves about a 70% rate of SVR with her acutely infected
patients. Exactly how early treatment needs to be for this kind of success rate
is currently being investigated in a study by the St Mary’s team.
Once you get into
treating chronic infection, success rates go down, and genotype makes a
difference. The largest study of treatment in co-infected people, the APRICOT
study,15 achieved an SVR for more than 60% of patients with
genotypes 2 and 3 but less than 30% of patients with genotype 1 - and let’s not
forget that these are the majority.
confirms that it’s largely fear of side-effects that stops people taking the
treatment. The chief side-effects are muscular aches and pains, fluey symptoms
and depression, due to the interferon, and anaemia and low white blood cell
count, caused by the ribavirin. Interferon will also cut your CD4 cell count by
an average of 140, so if yours is low, it might not be the time to start. There’s
no doubt the side-effects can be severe and difficult to tolerate: in the
APRICOT trial, a quarter of patients stopped taking their treatment. But Garry
feels some of this fear is misplaced.
“I think the side-effect
horror stories are really unhelpful. There’s an incredibly wide range of
experiences, from people who have shocking side-effects to ones who have none
“The biggest thing
I noticed was more intense feelings and some problems getting to sleep. I’ve
always been the type who cries at movies, but it made me much more emotional. I
also felt as if I was coming down with the flu after one of my injections,
though only for an afternoon. But on the whole, and speaking only for myself, it’s
been very tolerable. As for injecting, I was very nervous about the idea
especially as I don’t have much body fat to inject in. But apart from a little
bruising I’ve had no mishaps and the needle is so fine you hardly feel it going
“At the same time,
I’d rather do without any side-effects. I’m due to take 48 weeks of treatment
but my hepatitis C viral load came down from 1.3 million to undetectable within
eight weeks and I’ve asked my doctor if I can get away with 24 weeks.” The
generally accepted guideline in hepatitis treatment is that if you are not
undetectable for hepatitis C within twelve weeks, you are highly unlikely to
achieve an SVR but there is little consensus about how long treatment needs to
be in people with HIV.
There is a huge
research programme underway looking at new treatments for hepatitis C and more
than 50 candidate drugs are in human trials. We don’t have enough room in this
issue to look at future hepatitis C options and will examine them in a