Combating HCV with Better Education
Ignorance about HCV and HIV/HCV coinfection drives today's worldwide HCV epidemic. Education for physicians and for individuals at risk has begun to improve, but still falls short of the high level of public awareness needed for real change to take place.

Screening standards, not just for intravenous drug dealers
Because the chief HCV transmission route in the U.S. is injection drug use, a concerted effort is needed to make drug users aware of their extremely high risk and to recommend that they have immediate screening. However, intravenous drug users are not the only group at risk for HCV and HIV/HCV coinfection.

People with tattoos or body piercing represent a growing population that in all likelihood has been exposed to HCV. Another high-risk group consists of every person who received a transfusion of blood or blood products before 1990. Before that time, the blood pool was not screened for HCV. Since it takes 20 to 30 years for liver damage to be detected, a large group of people who were given blood before screening began may have had HCV for several years, and are not yet or only now becoming symptomatic.

Who should be tested now?
You should be tested for HCV or HCV coinfection if you:

• Had transfusions of blood and blood products before 1990, the year screening of the blood pool began
• Have had body tattooing and piercing
• Engage in intravenous drug use

In addition, if you are a patient or a healthcare worker, be sure to answer the simple questionnaire that accompanies this article and give it to your doctor.

How to prevent transmission
To prevent transmission, intravenous drug users should:

• Never share needles or other preparation equipment
• Sterilize syringes with boiling water (failing that, use only fresh tap water to clean syringes)
• Use new or disinfected containers and equipment
• Alcohol-swab the injection site
• Dispose of used syringes

Drug users who do not inject should be still aware that hepatitis C is associated with nasal drug use‹do not share straws!1,2,3

In populations where body piercing and tattooing and intravenous drug use are common, the risk of HCV infection is especially high. Prison populations in most nations now face an epidemic of HCV. One study of the Swiss Hindelbank prison for women, presented at the 1998 World AIDS Conference by Joachim Nelles of the Psychiatric University of Berne, found that prisoners generally understood risk factors for HIV infection but had a poor understanding of their risk of hepatitis infections. In one recent year, HCV infection at the Hindelbank prison was 60 times higher than in the outside community.4

What to do for coinfected individuals
Treatment for HCV is improving, even for coinfected people. Many recommendations for managing HCV were presented at the 7th Conference on Retroviruses and Opportunistic Infections, including the following5:

Screen all HIV-infected people for HCV antibody
• Advise patients to limit alcohol use
• Screen for hepatitis A (HAV) antibody; if negative, give HAV vaccine
• Monitor liver enzymes, especially during HAART
• Evaluate patients for extent of liver disease and appropriate treatment

Since HCV is a significant HIV complication, and is considered by some to be a major HIV opportunistic infection, broad-based screening for HCV in HIV-positive patients must become a diagnostic standard for AIDS-treating physicians. If the epidemic is to be stopped or even slowed, it is critical that we educate physicians and patients to ask the right questions in order to screen for HCV.

You can access up-to-date information about HIV/HCV coinfection through several websites, including http://www.hivandhepatitis.com and http://www.hcop.org. Information can also be accessed through the major HIV/AIDS sites, including but by no means limited to Medscape and thebody.com.

references
1. CDC. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. MMWR 1998;47 (No. RR-19).

2. Villano SA, Vlahov D, Nelson KE, Lyles CM, Cohn S, Thomas DL. Incidence and risk factors for hepatitus C among injection drug users in Baltimore, Maryland. J Clin Microbiol 1997; 35:3274-7.

3. U.S. Public Health Service. HIV prevention bulletin: medical advice for persons who inject illicit drugs. May 9, 1997. Rockville, Maryland: CDC, 1997.

4. Hepatitis C virus (HCV) and HIV coinfection. J Intl Assoc Physicians in AIDS Care. 12th World AIDS Conference. September, 1998.

5. O'Brien WA. Hepatitis B and C virus coinfection with HIV. 7th Conference on Retroviruses and Opportunistic Infections. January 31, 2000. , Medscape Inc. Accessed on Medscape June 6, 2000, at : http://www.medscape.com/ medscape/cno/2000/retro/Story.cfm?story_id=1018.