Communities and populations at high risk for HIV infection are also likely to be at risk for coinfection with hepatitis B virus (HBV) or hepatitis C virus (HCV). HIV, HBV, and HCV are bloodborne pathogens transmitted through similar routes, for example, via injection drug use (IDU), sexual contact, or from mother to child during pregnancy or birth. A substantial proportion of HIV-infected individuals are coinfected with HBV, HCV, or both viruses, and in the context of effective HIV therapy, liver-related morbidity and mortality among HIV patients is a significant challenge. Current approaches to management of HIV/HBV and HIV/HCV coinfection are detailed in this course.
HEPATITIS C IN THE HIV-INFECTED PATIENT
HCV and HIV have similar modes of transmission, but the transmission efficiency of each virus differs substantially. HCV is primarily transmitted by percutaneous exposure to blood – namely, via IDU. Coinfection with HCV and HIV is relatively common given the shared routes of transmission, and about 30% of all HIV-infected persons in the United States are also infected with HCV. The prevalence of HIV/HCV coinfection varies depending on the route of HIV transmission, ranging from 10–14% among persons reporting high-risk sexual exposure to approximately 85–90% among those reporting IDU. Despite the lower prevalence of chronic HCV infection among persons not engaged in IDU, recent outbreaks of acute HCV infection have been reported among HIV-infected men who have sex with other men, particularly those who engage in unprotected, traumatic sexual practices.