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Coinfection of HIV/HCV

The presentation will cover the concept of coinfection of HIV/HCV. Submitted From: Vijay Ramkumar, Hamdan Chowdhury, Nelson Hu, Ivana Loncar, Hyona Park, and Phuc Tong. Submitted to: Professor: Dr. Robert Travers. Course: SOC309 - UofT

Vijay Ramkumar

on 4 July 2012

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Transcript of Coinfection of HIV/HCV

Hepatitis C 101
Hepatitis C is a chronic liver disease which is caused by the hepatitis C virus (HCV)

HCV is spread through blood-to-blood contact

Common symptoms: fatigue, reduced appetite, sore muscles, nausea, abdominal pain or jaundice. HCV can lead to liver cancer

Educate yourself!
Coinfection 101
HIV/HCV Coinfection - The simultaneous infection of HIV and the HCV

Better HIV healthcare means more time for HCV to develop

Effects on the Liver

Cirrhosis, liver cancer, and other liver diseases
How HIV and HCV Effect Each Other
HIV infection leads to higher HCV blood count which means, faster progression

Controversies on how HCV genotypes affect transmission to HIV

HCV has several genetic variations called genotypes

Many stay untested which leads to False negatives

Regular testing if you are an IDU

Hep C medicine alone is strong
Treatment (cont.)
Interferon; Peg Interferon


Antiviral Medication

Which one you take is based on how much your body can handle
General Care for Coinfection
Exercise / Sleep
Avoid alcohol and drugs
Razors/ Toothbrushes
Safer Sex
Coinfection, Socially
The fear & stigma of HIV & HCV complicate social relationships

Social determinants of health may increase rates of coinfection

Coinfection and the link between Injection drug user (IDU) and homelessness
High infection rates among the prison population

High proportion of those incarcerated use illicit drugs

Lack of harm-reduction interventions

Other risk factors include, unsafe body piercings, tattooing,
unprotected sex with other IDUs

Coinfection in MSM Community
Lack of knowledge

Coinfection can threaten the sense of community
between HIV+ men with other HIV+ men

Silence and shame when it comes to (non)disclosure

Risker sex practices can lead to Coinfection
Coinfection, Politically (correct)?
Stephen Harper during 2006 election campaign: “We as a government will not use taxpayers’ money to fund drug use” (Dooling and Rachlis 1442)
Why Use a Safe Injection
Facility (SIF)?

Decreases amount of public drug use

Provides IDUs with onsite medical care

Decreases drug litter
Insite - Supervised
Injection Site

Established in 2003 in Vancouver as first SIF in North America

No increase in drug dealing, drug uses

Over 10 years estimated savings of $18 million in treatment costs and save 1175 life-years
Harper’s Fight Against Insite
Harper government removed harm reduction approach and tried to reverse Insite’s exemption

Federal government has tried to close down 3 times

Federal government ceased funding for Insite
Fig. 1. National Anti-Drug Strategy Funding by Category
Harper’s Fight Against Insite (cont.)
Canada’s anti-drug policy funding of 64 million:
The Lack of Canadian Support for Harm Reduction in Prisons
Harper government enacted new laws that will lead to increase in incarceration of drug users

Harper government moved away from 2005 Canada’s National Framework for Action

2006 government axed a $600,000 pilot tattoo program
International Policies
Prison needle exchanges in other countries – eg. Switzerland, Germany, Spain, Armenia

No increase in drug use
Reduction in HIV/HCV
No cases of needles being used as weapons against staff
Benefits of Harm Reduction in Prisons
Prison needle exchange helps:
Reduce overdose deaths
Reduce medical costs and provide treatment for addiction
Cost to prison system to treat inmate for:
HCV: $26,000
HIV: $29,000
UN supports needle exchange programs – no NEP in federal or provincial prisons
Harper’s Fight Against Insite (cont.)
Federal government ignored scientific evidence in support for Insite and misled public about its benefits

“although the use of illicit drugs does pose a risk to life and security of the person, ‘these risks are attributable to the substances themselves and not the laws prohibiting their possession and distribution’"
Educate Yourself
Get Tested!
The Social determinants of health
Be Positive About Being +
Sifs & Prison Programs Save lives & Money!
1. Center For Disease Control (CDC). “Hepatitis C Virus and HIV Coinfection”. CDC, 2002. Web. 9 Mar. 2012. www.cdc.gov/idu/hepatitis/hepc_and_hiv_co.pdf. 

2. “HIV and Hepatitis C Co-Infection." Catie: Canadian AIDS Treatment Information Exchange (2009): 1-8. Web. <http://www.hepcinfo.ca/en/resources/hiv-and-hepatitis-c-co-infection>.

3. Owen, Gareth. "An ‘elephant in the room’? Stigma and hepatitis C transmission among HIV‐positive ‘serosorting’ gay men." Culture, Health & Sexuality: An International Journal for Research, Intervention and Care 10, no. 6 (2008): 601-610. Print.

4. Rourke, Sean B. and Sobota, Michael, et al. "Social determinants of health associated with hepatitis C co-infection among people living with HIV: results from the Positive Spaces, Healthy Places study." Open Med 151, no. 3 (2011): 132-133.

5. Danta, Mark and Brown D, Bhagani S, et al. “Recent epidemic of acute hepatitis C virus in HIV-positive men who have sex with men linked to high-risk sexual behaviours.” AIDS no. 21(2007): 983–91. Print.

6. Broadhead, Robert S., Thomas H. Kerr, Jean-Paul C. Grund, and Frederick Altice. "Safer Injection Facilities in North America: Their Place in Public Policy and Health Initiatives." Journal of Drug Issues 32, no.1 (2002): 329-355. Print.

7. Dooling, Kathleen, and Michael Rachlis. "Vancouver's Supervised Injection Facility Challenges Canada's Drug Laws." CMAJ: Canadian Medical Association Journal. 182.13 (2010): 1440-1444. Print.
Notes (Cont.)
8. Bayoumi, Ahmed M., and Gregory S. Zaric. "The Cost-Effectiveness of Vancouver's Supervised Injection Facility." CMAJ: Canadian Medical Association Journal 179, no. 11 (2008): 1143-1151. Print.
9. Wells, Paul. 2011. “Harper swing and misses on Insite.” Maclean’s, Oct 10. Retrievied February 29, 2012 (http://www2.macleans.ca/2011/10/10/swing-and-a-miss/).

10. Wood, Evan, Thomas Kerr, Mark W. Tyndall, and Julio S.G. Montaner. "The Canadian Government's Treatment of Scientific Process and Evidence: Inside the Evaluation of North America's First Supervised Injecting Facility." International Journal of Drug Policy. 19. (2008): 220-225. Print.
11. Debeck,K., Wood,E., Montaner,J., &Kerr,T. (2009). “Canada’s new federal National Anti-Drug Strategy’:An informal audit of reported funding allocation”. International Journal of Drug Policy. 20. (2009): 188-191. Print.

12. Webster, Paul. “The redlining of harm reduction programs”. Canadian Medical Association Journal. 18, no.1 (2012): E21-E22.

13. Kondro,Wayne. “Prison tattoo program wasn’t given enough time”. Canadian Medica Associaiton Journal. 176. no. 3 (2007): 307-308.
14. Kendall, P. "A Reality-Based Prescription for Bloodborne Diseases Within the Corrections System." Canadian Journal of Public Health. 96.2 (2005): 93-96. Print.

15. Elliot,Richard. “Deadly disregard: government refusal to implement evidence-based measures to prevent HIV and hepatitis C virus infection in prisons”. Canadian Medical Association Journal. 177. no. 3, (2007): 262-264. Print.
Secondary References
Belluz, Julia. 2011. “Insite:Too Early to tell if it works.” Mcclean’s, Nov 17. Retrievied February 29, 2012 (http://www2.macleans.ca/2011/11/17/insite-too-early-to-tell-it-works/).
"Canada News: Massive Conservative crime bill set to pass after brief delay by NDP - thestar.com." News, Toronto, GTA, Sports, Business, Entertainment, Canada, World, Breaking - thestar.com. http://www.thestar.com/news/canada/politics/article/1144872--massive-conservative-crime-bill-set-to-pass-after-brief-delay-by-ndp (accessed March 12, 2012).
Carol Bova, Lisa Fink Ogawa, Susan Sullivan-Bolyai. “Hepatitis C Treatment Experiences and Decision Making Among Patients Living With HIV Infection”. Journal of the Association of Nurses in AIDS Care 21, no. 1, 2010: 63-74.
"Co-infection with HIV." Hep C Info. Web. 19 Mar. 2012. <http://www.hepcinfo.ca/en/detail/what-hepatitis-c/co-infection-hiv>.
Hathaway, A., and Tousaw,K.I. “Harm reduction headway and continuing resistance: Insights from safe injection in the city of Vancouver”. International Journal of Drug Policy. 19. (2008): 11-16.
Health Canada. "It's Your Health - Hepatitis C [Health Canada, 2009]." <http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/hepc-eng.php> (accessed March 10, 2012).
Jurgens, Ralf, Andrew Ball, and Annette Verster. "Interventions to Reduce HIV Transmission Related to Injecting Drug Use in Prison." Lancet Infectious Diseases. 9.1 (2009): 57-66. Print.
Marshall, B. Milloy,M.J,Wood,Evan, Montaner,Julio.Kerr,Thomas. “Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study” Lancet. 377. (2011): 1429-1437.
Milloy, M.J, Wood,Evan, Small,Will, Tyndall, Mark, Lai,Calvin,Montaner,Julio, & Kerr,Thomas. “Incarceration experience in a cohort of active injection drug users”. Drug and Alcohol Review”. 27 (2008):693-699.
"Peg-interferon and Ribavirin." Hep C Info. Web. 21 Mar. 2012. <http://www.hepcinfo.ca/en/detail/treatment/treatment-regimen/peg-interferon-and-ribavirin>.
"Treatment for HIV and Hepatitis C." Hep C Info. Web. 20 Mar. 2012. <http://www.hepcinfo.ca/en/detail/treatment/treatment-hiv-and-hepatitis-c>.
HIV 101
HIV (Human Immunodeficiency Virus) is a virus that attacks the immune system. When the body can no longer fight infection, the disease has progressed to AIDS (Acquired Immune Deficiency Syndrome)

For a person to become infected with HIV, the virus must enter the bloodstream (e.g. engaging in unprotected sexual intercourse, sharing needles)

Treatment is available, however it is life long process
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