Module 9: Co-infection with HIV - section 2

In this document:

HIV/HCV Co-infection prevalence in PWID

Activity: Presentation and group discussion
Section Time: Approximately 30 minutes

The purpose of this section is to build on the previous activity, consider the factors that contribute to HIV/HCV transmission among PWID and to develop awareness around regional and local prevalence rates

Introduce Slide 9.4 (Hepatitis C Among Injecting Drug Users in the New EU Member States and Neighbouring Countries) and explain that this report highlighted particular concerns across the region:


Use Slide 9.5 (WHO European Region HIV/HCV co-infection prevalence) to support large group discussion:


Facilitate discussion by asking:

  • To what extent does this prevalence data reflect your experience?
  • Why are the factors that contribute to local prevalence rates?

Show Slide 9.6 (Regional challenges to HIV/HCV co-infection) :


Facilitate discussion by and highlighting the challenges posed by co-infection and asking:

  • Why the majority of those with HIV/HCV co-infection are not treated?
  • What are the implications for not testing and treating those with co-infection?
Supporting content:

‘HCV co-infection with HIV is common particularly among active and former PWID, who acquire both viruses from injecting drugs. Such co-infection reduces the chance of recovery from acute HCV, compromises the effectiveness of existing HCV treatment, and accelerates the progression of HCV infection to cirrhosis and liver failure. On the other hand, liver disease is becoming one of the lead causes of death in PLWHA. In Western Europe, where ART is widely accessible, the most frequent causes of death in co-infected people are related to liver disease—more often than to AIDS-defining infections. This trend represents a striking change in the epidemiology of HIV and AIDS-related deaths, which previously were due more to opportunistic infections rather than co-infections.’

Merkinaite S and Knerr W (Eds.) (2007) Hepatitis C among injecting drug users in the new EU member states and neighbouring countries: situation, guidelines and recommendations. Vilnius: Central and Eastern European Harm Reduction Network (CEEHRN).

 ‘In Europe, the prevalence of hepatitis C virus (HCV) infection in HIV-infected patients is particularly high – and still rising, in contrast to the rest of the world. Yet only a minority of HCV/HIV- co-infected patients is treated for their hepatitis. The compounding effect of co-infection makes the care for these patients a major challenge.

With the development of HAART, morbidity and mortality among HIV-infected patients have decreased significantly. The consequences of liver-related disease associated with chronic HCV infection are now far more worrying. End-stage liver disease (ESLD) is now the predominant cause of death in patients co-infected by HCV and HIV.’

Management of Hepatitis C and HIV Co-infection: Clinical Protocol for the WHO European Region (WHO 2007)

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