Special Considerations When You Have Hepatitis C and HIV


Linda Wasmer Andrews

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Anyone can get hepatitis C, a viral infection that may lead to liver inflammation and cirrhosis. But the risk is compounded when you have HIV. About one-fourth of people living with HIV have the hepatitis C virus (HCV) as well. Among those with HIV who inject illegal drugs, 80% are also infected with HCV.

Doctors have learned a lot in recent years about how to manage hepatitis C and HIV together. If you have both conditions, here are some things you should know.

The HCV-HIV Connection

First, it helps to understand how you may have gotten here in the first place. The relationship between HCV and HIV is complex. Certain behaviors increase the risk of getting both viruses. They include injecting illegal drugs, having unprotected sex with multiple partners, and engaging in sex acts that may lead to bleeding. Having other sexually transmitted diseases also increases the risk for both hepatitis C and HIV infection.

If you’re already infected with HIV, your body’s defenses against hepatitis C may be weakened. Some people with HIV infection believe that it’s safe to have unprotected sex with others who are also HIV-positive. Unfortunately, this increases the chance of being exposed to diseases such as hepatitis C.

A Double Dose of Trouble

At Your Appointment

What to Ask Your Doctor About Hepatitis C

Without proper treatment, the one-two punch of HCV and HIV can be bad for both conditions. Having HIV can speed up the rate at which hepatitis C worsens over time. This triples your risk for liver failure and death from liver disease. In fact, liver disease—much of it caused by either hepatitis C or hepatitis B—is now the leading cause of non-AIDS-related death in people with HIV.

At the same time, having HCV can complicate the treatment of HIV infection. For one thing, it may increase the risk for liver side effects in patients on ART (antiretroviral therapy)—a mix of drugs that help delay or prevent the development of HIV symptoms and AIDS. The benefits of ART still far outweigh the risks for most people. But extra care may be needed when hepatitis C enters the picture.

Get Tested, Get Treated

Because HCV and HIV so often go hand in hand, if you have one, the Centers for Disease Control and Prevention (CDC) recommends getting tested for the other. Talk with your doctor about whether you need to be retested on a regular basis and, if so, how often.

If you’ve already been diagnosed with both HCV and HIV infection, effective treatments for both conditions are available today. Chronic hepatitis C is usually treated with drugs that attack the underlying virus. HIV infection is treated with ART.

What the Treatment Guidelines Say

Most people with both conditions should begin drug treatment with ART, according to guidelines from the U.S. Department of Health and Human Services. Along with controlling HIV, ART may actually slow the worsening of liver disease, thanks to reduced inflammation and better immune functioning.

There are three possible treatment approaches:

  • Starting ART and delaying hepatitis C medication. HIV patients with hepatitis C are usually placed on the same ART regimen as those without hepatitis C. The guidelines say that taking additional medication to treat hepatitis C can sometimes wait, especially in people with little or no liver damage.

  • Starting hepatitis C medication and delaying ART. The guidelines say that this isn’t the best choice for most people. Doctors occasionally recommend it for those who have never been treated with ART and whose immune system is still strong.

  • Taking both ART and hepatitis C medication at the same time. This may be necessary if hepatitis C has already harmed the liver. Combining two treatment regimens increases the risk for drug interactions and side effects. But those risks often can be managed by adjusting the treatment plan—and the benefits can be lifesaving. Look for a doctor with expertise in treating both conditions.

Key Takeaways

  • Having HIV can speed up the rate at which hepatitis C (HCV) worsens over time. This triples your risk for liver failure and death from liver disease.

  • At the same time, having HCV can complicate the treatment of HIV infection.

  • Because HCV and HIV so often go hand in hand, if you have one, you should get tested for the other.

  • Most people with both conditions should begin drug treatment with ART.

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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Apr 7, 2016

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Medical References

  1. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents. U.S. Department of Health and Human Services. http://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/26/hiv-hcv
  2.  What I Need to Know About Hepatitis C. National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases. http://www.niddk.nih.gov/health-information/health-topics/liver-disease/hepatitis-c/Pages/ez.aspx
  3. HIV and Viral Hepatitis. Centers for Disease Control and Prevention. http://www.cdc.gov/hepatitis/Populations/PDFs/HIVandHep-FactSheet.pdf
  4. HIV Basics: Testing. Centers for Disease Control and Prevention. http://www.cdc.gov/hiv/basics/testing.html
  5. HIV Transmission. Centers for Disease Control and Prevention. http://www.cdc.gov/hiv/basics/transmission.html 
  6. What Is HAART? National Institutes of Health. National Institute on Drug Abuse. https://www.drugabuse.gov/publications/research-reports/hivaids/what-haart
  7. Sex and Sexuality: Entire Lesson. U.S. Department of Veterans Affairs. http://www.hepatitis.va.gov/patient/daily/sex/single-page.asp
  8. Taylor LE, et al. HIV coinfection with hepatitis C virus: evolving epidemiology and treatment paradigms. Clin Infect Dis. 2012;55 Suppl 1:S33-42.

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