Co-managing HIV and Hepatitis C
HIV and Hepatitis C present a unique set of challenges to the individual living with them in tandem. It is known that some viruses, when active in the presence of HIV, actually serve to increase HIV’s activity. Further, Hepatitis C appears to move more quickly toward liver disease in the person also living with HIV. And while they share the title "virus" in common, they differ significantly. There are generic approaches that would improve the way a person’s body handles either one of these viruses, and very specific therapies that must be applied to each virus individually. Further complicating the issue, Hepatitis C is a silent virus. It is thought that a person could be carrying Hepatitis C for 20-30 years without knowledge of their diagnosis. It is likely that many times more people in the United States are Hepatitis C positive than are currently diagnosed as such. Since it is a blood borne pathogen, it is spread in same way that HIV is spread. If a person has been exposed to HIV, they should seriously consider ruling out Hepatitis C with a blood test.
If Hepatitis C is a silent virus, why would a person care to know about it before symptoms presented themselves? Especially since once a person contracts a virus, it lives with them for the rest of their life. Further, why would a person living with HIV be concerned about Hepatitis C, when they are preventing the spread of it with the safe sex that they currently practice in light of their HIV status? The answers to these questions include consideration of conventional versus natural supportive therapies, and the clinical interaction of the HIV and Hepatitis C viruses.
Conventional options for the prevention of Hepatitis C do not include any type of vaccination, because the virus "mutates" constantly, even within the same person, over the course of his or her life. There are two conventionally accepted and used treatment protocols for use once a person has contracted the Hepatitis C virus. The first protocol is interferon alpha. Response to this protocol is very disappointing. Only 10-15 percent have a positive sustained response of viral clearance that lasts at least six months. Further, this is a drug, a substance that your Hepatitis C-challenged liver must metabolize. The side effects are very uncomfortable and include nausea, headache, fever, body pain, fatigue, anemia, hair-loss, irritability, thyroid, lung and eye problems. That is a hefty price to pay for such small short-term gains. Even worse, the second protocol is the combination of interferon alpha and ribavirin. This protocol has a longer period of viral clearance, and for more people. This combination has a 28-66 percent positive response for at least 48 weeks. The very bad news is that this drug combination costs approximately $2000 per month, and the side effects are described as "universal, significant and possibly serious." I have talked with people that have experienced this very expensive treatment protocol. Their description of the side effects is daunting.
According to the World Health Organization "it is estimated today that about 20% of patients with chronic infections develop cirrhosis, and that 1% to 5% of cirrhotic individuals will develop cancer of the liver during the next 10 years." Cirrhosis of the liver is irreversible, and liver cancer is very difficult to treat. Therefore considerations for supporting a patient with Hepatitis C must include the prevention of these two disease states. This makes early diagnoses, and preventative treatment vital to longevity and optimal well being for the person living with Hepatitis C. Liver-related death rates are considered to be 94 times higher in those also living with HIV, than those carrying only the Hepatitis C virus. This makes early diagnosis and preventative treatment against the progression of liver disease that much more important to a person living with the two viruses. Like HIV, there is no vaccination against Hepatitis C. Exposure to blood and body fluids must be safe-guarded against in order to prevent contracting Hepatitis C. Conventionally, not much is done preventatively for two major disease states that may eventually manifest in the person living with Hepatitis C. Naturopathically, however, there is much to be done!
Naturopathic physicians look toward working with the body, and any virus that may have established residency there. Natural agents make their biochemical applications at a causal, rather than a symptomatic level, correcting damage and imbalance of normal cell, tissue and organ function. Most pharmaceutical agents take a toll on the body, and their benefit must be carefully weighed against their "cost." The liver is the first organ to suffer a prescription medication. When the liver is the organ that is suffering from the virus Hepatitis C, it is a difficult to decide to tax it further. Especially when the benefits of that drug are few, and the side effects are exceedingly uncomfortable.
First, the application of general wellness therapies go a long way toward living well with these viruses. When a body is strong, its immune system is intact, and its over all state of health runs high. Conversely, the activity of a virus of any sort runs lower. This is basic common sense. We all know that a cold sore is a virus, for example, and that the more stress we endure, the poorer our diets, the less sleep we get, the more often they express themselves. In a strong healthy individual, the cold sore virus may lie dormant for months or even years. The virus remains unchanged. It is the immune status that serves as the variable in this scenario. Secondly, there are very specific natural therapies for viruses in general, and the Hepatitis C in particular. Finally, studies show that the Hepatitis C virus itself is not the only thing that leads to "trouble" for the person living with Hepatitis C. It is also the oxidative stress, and the special way that fat accumulates and breaks down in a Hepatitis C infected liver that leads to cirrhosis, cancer and a poor prognosis for someone living with Hepatitis C.
Oxidative stress, inflammation and the improper metabolism of fat in the liver leads to the fibrotic changes in cirrhosis, and the increase cellular proliferation in liver cancer that are the two most serious manifestations of Hepatitis C long-term. Instead of merely attacking the virus, natural therapies for the treatment of someone living with both HIV and Hepatitis C must include generic anti-viral agents, and agents that research has shown to suppress the HIV and the Hepatitis C viruses in particular. Immune support for the system compromised by the immune compromising HIV virus, and in order to prevent the Hepatitis C virus from expressing itself in a compromised immune environment. Liver protection and support in the presence of the destruction that Hepatitis C inflicts upon the liver. Liver cancer prevention in the face of an increased incidence of liver cancer coinciding with the presence of the Hepatitis C virus. Anti-inflammatory and anti-fibrotic agents in order to support healthy connective tissue production and prevent the scarring and subsequent death of liver tissue associated with Hepatitis C. Anti-oxidant protection of the normal levels of fat in the liver, and lipotropic agents to remove the over accumulation of fat deposits associated with Hepatitis C. To make this therapy specific for co-treating HIV and Hepatitis C, there must be a focus upon vitamins, minerals, herbs and herbal extracts that have been proven in studies to directly affect HIV and Hepatitis C activity, and the destruction to the immune system and liver tissue associated with these two very different viruses. During the administration of natural therapies, people forego the uncomfortable, serious, or unacceptable side effects associated with conventional therapies. Instead, they experience a stronger immune system, enhanced liver function and liver cell health, lower liver enzymes, increased energy levels, improved digestion and decreased depression.
Natural therapies for the co-treatment of HIV and Hepatitis C may include:
Anti-oxidants – Oxidative stress and lipid peroxidation in the liver leads to the cellular biological changes that result in fibrinogenesis, and eventually to life-threatening cirrhosis of the liver. Studies have shown anti-oxidant therapy to decrease hospital stays, improve response to therapeutic drugs, and stop fibrinogenesis in people with hepatitis of various causes. Additionally, anti-oxidants have been shown to raise CD4+ cells. This is considered an important goal in people living with HIV. Further, people living with HIV are known to demonstrate low systemic levels of the anti-oxidant vitamins A and E, and mineral zinc. This decreases their natural opportunity to produce CD4+ cells, and to prevent the lipid peroxidation that leads to liver disease in the presence of the Hepatitis C virus. Anti-oxidants are: Vitamin A, C, E, alpha lipoic acid, co Q10, grape seed extract, milk thistle, N-acetyl cystein, selenium and zinc, among others. Note: as some of you may remember from an earlier "Dear Carrie Louise" column, zinc must be used carefully in the specific dose of 15mg of supplemented zinc per day. This is in addition to the average 15mg per day that the average person would obtain through diet, for a total of no more than 30mg per day. More than 30 mg per day is shown to lead to the progression of opportunistic infections associated with HIV.
Silymarin or milk thistle – Anyone interested in natural therapies, and currently taking protease inhibitors is probably also taking milk thistle. Milk thistle protects liver cells from toxic chemicals and free radical damage. It also prevents the inflammation that leads to the fibrotic changes in the liver that become cirrhosis, and actually promotes the body’s production of new liver cells. In the presence of Hepatitis C, this powerful plant has been shown to decrease liver enzyme levels and further decrease the lipid peroxidation that is so destructive to liver cells.
Glycyrrhiza or licorice root – Licorice root is known to stimulate the immune system, decrease inflammation and as a generic, and hepatitis-specific anti-viral. It supports over-stressed adrenal glands, and increases energy and over-all sense of well-being. It will prevent the lipid peroxidation that that leads to liver disease in the presence of the Hepatitis C virus. Specifically with the Hepatitis C virus, IV glycyrrhizin, an active constituent in licorice root, in combination with cysteine and glycine was shown to significantly improve liver biopsies in a relatively short period of time. When taken orally, glycyrrhizin changes into glycyrrhetinic acid. This form is less effective, however both forms demonstrate the ability to protect liver cells.
Uncaria gambir – This plant contains in important class of flavenoids called "catechins." Catechins have been shown in studies to protect liver cells. Catechins demonstrate anti-oxidant effects that prevent the lipid peroxidation that damages liver cells, and leads to the liver diseases associated with the Hepatitis C virus. Further, they are shown in studies to lower liver enzyme levels in various types of hepatitis. Liver biopsies show improvement in studies using catechins.
Beta-sitosterol – This substance may be found in plants such as saw palmetto, milk thistle, ginkgo, and especially wild yam. They have the unique ability to stimulate an immune response against a pathogen, such as a virus, while inhibiting the inflammation that would accompany such an immune response. In the presence of the Heptatis C virus, this becomes very important. Inflammation in the liver cells, where the virus lives, leads to fibrotic changes and cirrhosis. Beta-sitosterols are able to mount a response against the virus, while preserving the environment, protecting it from the damages of the inflammation that would other wise have resulted from such response. In many situations where the immune system was called upon to respond, the inflammation that it causes would not pose a problem. Hepatatis C infection of the liver cells is unique, in that the very response that kills that virus is also the response that leads to the liver diseases that threaten the well being of the person living with the virus. Therefore you must be careful when fighting this virus, not to cause inflammation. Beta-sitosterols are able to assist in this manner.
Dietary changes – Consider that the Hepatitis C infected liver will suffer dramatically from any toxin that it must encounter. Further, the liver is the organ designed to break down and process toxins. Therefore, any substance encountered by the body that is not a direct nutrient, must be processed by the liver. The Hepatitis C infected liver will move more quickly in the direction of cirrhosis and cancer when forced to process chemicals, colorings, preservatives, pesticides, herbicides, drugs, alcohol, caffeine, tobacco products, hydrogenated oils such as those found in margarine, and rancid oils such as those present in fried foods. The most success diet to follow would be one of whole, organic and natural foods, with plenty of clean water.
Nutritional and herbal supplements can run approximately $75 to $200 per month, depending on a person’s over all state of health, treatment goals, and whether it is an initial protocol or a maintenance protocol. This is 5-10 percent of the cost of the "treatment of choice" of the conventional medical providers. I believe that life extension and quality of life improvement for those faced with the unique challenge of HIV in combination with Hepatitis C lies within a person’s access to quality natural care.