[e-drug] Hepatitis C and AIDS

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E-drug: Hepatitis C and AIDS
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[Crossposted from SIGN. KM]

"Hepatitis C Poses New Threat to Many with AIDS"
New York Times (05.01.01) David Tuller

When the Food and Drug Administration (FDA) approved the first
protease inhibitors for HIV/AIDS in 1996, many people believed they had been
granted a reprieve from death. Yet thousands are now learning that their
longevity has left them with  a second disease, hepatitis C, which can lead
to liver cancer, cirrhosis and, in some cases, death.

Up to 40 percent of Americans with HIV-or 300,000 to 400,000
people-may be infected with the hepatitis C virus (HCV).  Among those who
have used intravenous drugs, the rate may be 90 percent. Among hemophiliacs,
rates are high due to past contaminated blood supplies.

"This is emerging as a really huge problem," said Alan Franciscus,
publisher of HCV Advocate newsletter and director of the Hepatitis C Support
Project in San Francisco. "Before protease inhibitors, most people died too
quickly from HIV-related causes to even know they were infected with HCV,"
which can take 20 years to become symptomatic. As the death rate from AIDS
declined, liver disease from hepatitis C became the number 1 cause of death
of those with HIV.

The hepatitis C virus is the deadliest of the three major varieties of
hepatitis. Almost four million Americans have been infected and 8,000-10,000
die annually from complications of the disease, according to the CDC. Ten
percent to 20 percent of those with the disease progress to cirrhosis or
some other fatal liver disease.

The treatment outlook has improved markedly, and the FDA has recently
approved a new form of interferon that is performing well in clinical
trials. Yet despite treatment advances, many do not benefit because of the
complications of medicating two different diseases. The antiretroviral drugs
used to treat HIV/AIDS place a great strain on the liver. Many doctors do
not know how to treat the co-infection, and only a handful of physicians
specialize in both diseases. It is easier to educate HIV doctors about HCV
than to tax HCV doctors with the new burdens of HIV knowledge.

Transplants have not been an option for people with HIV.  Transplant
centers have routinely rejected individuals with HIV as organ recipients
because their life expectancies were so short. But now a handful of programs
are looking at the candidacy of individuals with HIV as liver transplant
patients. However, according to Dr. Douglas Dieterich, chief of
gastroenterology and hepatology at Cabrini Medical Center in New York, "It
will be years before we see what the long term result of these studies are."

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"Hepatitis C in Canada is Projected to Increase Dramatically"
Associated Press (05.02.01)

The number of hepatitis C cases in Canada will increase dramatically in the
coming years due mainly to a continuing epidemic among injection drug users,
researchers said Wednesday. There is strong evidence that the virus is
transmitted by shared straws used in snorting cocaine and sores in the mouth
among crack smokers. Robert Remis of the University of Toronto said about
240,000 Canadians now have hepatitis C, with 3,000 to 8,000 new infections
annually, and deaths in the same order of magnitude.


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