Despite the serious realities of these conditions, there is a very positive outlook on HIV-hepatitis C co-infection:

• Successful treatment and significantly improved outcomes for HCV-infected people living with HIV/AIDS is possible with the latest drug regimens.
• Side effects can be effectively managed to ensure treatment success.
• Liver (and kidney) transplants are possible for people living with HIV/AIDS, and Mount Sinai is investigating their effectiveness as a treatment for HIV-HCV co-infection.

Viral infections, including HIV and HCV generally cause few or no symptoms during the early stages of infection. However, the immune system can produce special proteins called antibodies as a reaction to the presence of a foreign substance-in this case, the virus-long before the onset of symptoms. First-line antibody screening tests look for these proteins as an indicator of infection.

These tests are very sensitive to the early signs of infection, but they are often less accurate than others that detect the virus. For this reason, a second test often follows a positive screening to confirm the virus is present.

For HIV:

• The ELISA test (Enzyme Linked Immunosorbent Assay), looks for HIV antibodies in blood. If antibodies are detected, the test must be confirmed before a person can be considered HIV positive.
• The Western Blot or Immunoflouroscent Assay (IFA) is performed to confirm a positive ELISA result.

For HCV:

• An EIA test (Enzyme Immunoassay) also looks for HCV-specific antibodies in the blood. A reactive (positive) result indicates likely exposure to hepatitis C at some point in time. Positive EIA test results must be confirmed.
• PCR - A PCR (Polymerase Chain Reaction) test measures the precise concentration, or viral load of HCV in the blood. A PCR test may be used to provide confirmation of HCV status or to monitor the effects of treatment.
• Liver Function Tests - Liver function tests look for a variety of substances in the blood that help to indicate how well the liver is able to perform its normal activities. When the liver is impaired or damaged, the levels of these substances may change. Since the virus as well as the drugs used to treat HCV may affect the liver directly, it is very important to monitor liver function on a regular basis.
• Genotype - There are at least six distinct varieties, or genotypes, of hepatitis C. The genotype of the virus may affect the course of the illness as well as the response of the virus to treatment. In addition, infection is possible with more than one genotype of HCV-greatly complicating the course of treatment. Therefore, it is important for patients to know their own genotype of HCV and to avoid exposure to other varieties of the virus.

Co-Infected individuals may also be prescribed the following tests:

• Liver Biopsy is the removal of liver tissue with a needle. Currently it is the most accurate means to assess liver inflammation and scarring - key measures of the progression of HCV-related liver disease. Such measures help physicians accurately determine the stage and cause of liver disease, plan future treatments, and assess the effectiveness of current treatments. Drawbacks of the procedure include pain, as well as rare but potentially serious complications.
• Transient Elastography is a safe and non-invasive test that uses ultrasound to measure the stiffness of liver tissue. This test, shown to correlate well with results collected via liver biopsies, is not yet FDA approved. However, active research is underway to determine the feasibility of using transient elastography as an alternative to invasive biopsies in the treatment of HCV-related liver disease.