Coping with Coinfection | Page 2

For hepatitis C virus patients coinfected with HIV, the everyday challenges of managing their condition are amplified.
“Interferon and ribavirin did not work very well for HIV-positive people and had lots of side effects. Now, that’s changed. People have a great chance of being cured,” Swan said. “Treatment is much better now than it was a few years ago. Coinfected people are much more likely to be cured with the new HCV drugs than interferon and ribavirin.”

Understanding Adherence

Doctors must continue to monitor coinfected patients, not just for interactions between their medications, but also to take stock of their alcohol and substance abuse and over-the-counter drug use, in order to manage their side effects and minimize drug interaction.

“It’s important for patients to understand exactly how to take their medications and which disease each medication is treating,” Hampton said.

A patient may see more than one doctor, such as a specialist in infectious disease and a hepatologist. While this could lead to more specialized care, in Gibbons’ case, she found herself having to connect the dots between what each health care provider said.

“There seemed to be some inability for the two teams to communicate, and so I had to learn a lot of my information and bear messages between the two teams,” Gibbons said.

Dr. Amesh A. Adalja is a board-certified infectious disease physician at the University of Pittsburgh Medical Center. Adalja noted that HCV treatments in years past often included 48 weeks of pill cocktails with side effects that led to severe anemia and lethargy in patients.

“There were severe side effects, and for 48 weeks, a patient would have to deal with the side effects—that’s almost a year,” he said.

Newer HCV treatments, in comparison, could require only a 12-week program, or even less, he added.

“It’s much less daunting to face, it’s a much easier sell, when side effects are [lessened] and the program is shorter,” Adalja said. “They can see a light at the end of the tunnel.”

The recently approved drugs are not just shorter programs, they cause fewer concerns when coupled with HIV treatment, Hampton added.

“The beauty of these new hepatitis C drugs, like Sovaldi and Harvoni, is that there are far fewer interactions between those products and HIV treatments, including commonly prescribed Atripla,” Hampton said. “Coinfected patients are now able to start hepatitis C treatment without discontinuing HIV treatment. Difficulties in adherence are fewer than ever, but perfect adherence has never been more important.”

Dutifully taking medications as prescribed is essential, whether treatment is 12 weeks or more than a year. Hampton said adherence becomes more important due to the cost of new medications, often $1,000 a pill. Swann believes that coinfected patients have better success with adherence, and thus have higher cure rates.

“HIV-positive people have experience with adherence, and in some HCV clinical trials, cure rates have been higher among coinfected people than people with HCV alone,” she said. “This is probably because of great adherence. HIV care has built in education about and support for adherence to antiretroviral therapy. People know why it is important to take medicines as prescribed, instead of simply being told to take it.”

Simon Farnworth, a nurse practitioner for HIV and HCV coinfection at Chelsea and Westminster Hospital in London, works at Kobler Clinic, one of the largest HIV treatment centers in Europe. His role involves diagnosing, treating, and supporting patients with HCV.

“The main issue with the new meds is drug–drug interactions, and we often have to change a patient’s HIV meds in order to minimize these,” Farnworth said. “This can be somewhat disruptive, and patients often worry that the HIV meds will stop working, particularly if they have been stable on them for many years.”

Keeping Hope Alive

Gibbons made dietary changes and practiced yoga, Reiki and other healthy habits to counter the weakened immune system she was told would be a result of coinfection. In 2012, she was able to clear HCV following a treatment regimen with interferon and ribavirin.

“Some of my friends’ deaths were contributed to by a weakened immune system. People kept reassuring me that it wasn’t a death sentence. So why were they using that phrase, I wondered,” Gibbons said.

Besides the physical impact, coinfection affects mental health and mood, which, in turn, affects relationships, Farnworth said.

“The main ways that I see patients’ lives impacted, particularly with interferon regimes, is the level of tiredness and lethargy they experience,” he noted. “This and other side effects, like mood changes, often result in strained relationships with family, friends and partners.”

Reddy said the stigma of the disease and its associations with IV drug use or unprotected sex can often create depressed feelings for the patient, who also see changes in how others treat them. Patients must use protective barriers, such as condoms, during sexual activity and be mindful of other ways the diseases spread, such as through shared needles or razors. Copeland said that disclosing to a potential partner will impact their relationship.

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