Hiv/hepatitis C coinfection poses a dilemma: Which virus should be treated first? U.S. docs often choose HIV, trying to shore up the immune system to better the hep C treatment’s chance of success. But in a study of 105 HIVers at Milan’s Vita-Salute San Raffaele University, those treated first for hep C got a leg up on their HIV treatment—and had less HAART-related liver damage. Although most of these Europeans had a highly treatable hep C strain—while most U.S. heppers have the harder-to-treat genotype 1—liver pro Douglas Dieterich, MD, of New York City’s Mt. Sinai med school says, “The Milan news applies here.” Why? Because treating hep C slows liver damage even if it doesn’t clear the virus. Dieterich adds that treatment priorities vary from patient to patient: Is the immune system weaker than the liver? Treat HIV first. Liver worse? Vice versa. As hep C treatments become more effective and easier on the body, taking them first may become the rule, protecting the liver from future HAART attack.
HEP Or HIV?
October 1, 2003 • By David Gelman, MD