According to the World Health Organization (WHO), 2 to 15% of those infected with HIV are also affected by HCV, increasing their risk of morbidity and mortality due to accelerated liver disease.
This suggests that interventions aiming to reduce the disease burden associated with HIV and HCV co-infection must consist of strategies to manage symptoms of each individual infection.
[citation needed] In contrast to HIV and HCV co-infection, there has been significant research delineating the signs and symptoms of each of these individual illnesses.
Common symptoms experienced by HIV-infected individuals include fever, night sweats, diarrhea, nausea, headache, and fatigue.
[3] On the other hand, symptoms associated with HCV infection include fatigue, depression, urticaria, peripheral neuropathy, joint pain, and irritability.
An individual can become infected with HIV if these fluids enter the bloodstream by way of a mucous membrane, damaged tissue or injection.
The virus is commonly spread by sharing needles, mother to infant during birth, improperly sterilized medical equipment, intercourse with an infected individual, and unregulated tattoos.
Studies have shown that in comparison to HIV, there is up to a 10 fold greater risk of transmitting HCV after contact with an infected needle.
[15] A positive result for a qualitative HCV RNA blood test confirms that the active virus is present in the individual's bloodstream and that the infection is chronic.
[21] In individuals living with HIV, anti-retroviral therapy (ART) has been shown to preserve immune function, reduce the effects of HIV-related inflammation, and delay hepatic disease.
Therefore, treatment plans for individuals with HIV/HCV co-infection include: an initial ART regimen (as recommended for HIV mono-infected individuals); simultaneous HCV treatment involving oral direct-acting antivirals (DAA); and special consideration given to potential for severe drug-drug interactions between the selected medication regimens.
[23] The overall goal of HCV DAA therapy is to create a Sustained Virological Response for 12 consecutive weeks (SVR12) to ensure the Hepatitis C virus is not detected in the blood.
[24] In clinical trials, the use of the following DAA combinations have shown similar efficacy rates (by achieving SVR12) in individuals with HIV/HCV co-infection as those with HCV mono-infection:[21] Elbasvir/Grazoprevir Glecaprevir/Pibrentasvir Ledipasvir/Sofosbuvir Due to limited clinical safety data, the following DAA combinations, while available, are not considered as first-line therapies:[21] Sofosbuvir/Velpatasvir Sofosbuvir/Velpatasvir/Voxilaprevir Barriers to care exist when discussing therapeutic options for HCV/HIV co-infected individuals.
For example, other co-morbidities such as severe hepatic decompensation, cardiac disease, and renal disorders contribute to treatment barriers since these individuals would not be eligible for anti-retroviral therapy.
[28][29] Individuals with continued alcohol/drug/substance abuse and those that exhibit depressive symptoms along with suicidal ideations are also subject to ineligible status for HCV treatment in HCV/HIV co-infected persons.
[31] With the significant global effect of each of these viruses, it is also important to note that there is a considerable overlap of HIV-positive individuals co-infected with HCV.
When considering this conflicting information, it is important to note that many of these studies were completed before the introduction of antiretroviral therapies for HIV, which are now the standard-of-care for HIV-positive individuals.