Hepatitis C and HIV Co-infection
Epidemiology of HIV and viral hepatitis co-infection
In Australia, it is estimated that about 13% of people with HIV also have hepatitis C. [Dore, G. & Sasadeusz, J. (Eds); 2006] It is possible that a person with HIV will not know they have either hepatitis B or hepatitis C unless they are specifically tested for the hepatitis viruses.
Both hepatitis B and hepatitis C are more common in people with Human Immunodeficiency Virus (HIV) than in the general population because of shared risk factors for viral transmission. HIV shares major routes of transmission with both hepatitis C and hepatitis B.
People who inject drugs are at particularly high risk for hepatitis C and HIV
co-infection. Sexual transmission is responsible for the majority of the cases of HIV-hepatitis B co-infections.
Disease course of HIV and hepatitis C co-infection
Current evidence suggests that HIV worsens hepatitis C-related liver disease and can fasten the progression to cirrhosis, decompensated liver disease and lead to earlier development of hepatocellular carcinoma (a form of liver cancer) because HIV decreases immunity. It is unclear what impact hepatitis C infection has on HIV progression. [Dore, G. & Sasadeusz, J. (Eds); 2006]
Testing for hepatitis C and HIV
A simple blood test will check whether you have hepatitis C and/or HIV. In some people who are co-infected with hepatitis C and HIV, the results of the first blood tests may be unclear or show a negative result. This could be caused by the HIV decreasing the antibody ‘markers’ for hepatitis C. It may be necessary to have ongoing blood tests that specifically look for the virus (PCR test) in order to make an accurate diagnosis.
If the results show co-infection with hepatitis C and HIV, it is important to find a doctor with experience in co-infection and HIV. An HIV/AIDS organisation or Hepatitis organisation will be able to suggest appropriate doctors. Regular blood tests and viral load tests are needed to track how fast the disease is progressing. Developing a good partnership with your doctor will help you feel comfortable about the management of your illness.
Treatment of HIV/hepatitis C co-infection
People with HIV can be treated for hepatitis C but it may be more complicated than treating either infection by itself, particularly if a person is on HIV treatment. The treatment for hepatitis C changed from March 2016 and is now simpler for most people with minimal side-effects. Due to the potential for adverse drug interactions between HIV medicines and hepatitis C medicines it is important that a person with HIV/hepatitis C co-infection receives specialised care from their doctor and other referred specialists
Having chronic hepatitis C can also affect HIV treatment choices due to the potentially toxic effects some HIV drugs have on the liver. The treatment options for people with HIV/hepatitis C co-infection changes depending on the degree of liver damage, as the liver cannot tolerate some of the antiviral drugs used in the treatment of HIV.
Taking care of your liver with HIV/hepatitis C co-infection
It is important for people who are co-infected with HIV and hepatitis C to have their liver function carefully and regularly tested. In addition, avoiding any damage or stress to the liver is vital. Refer to the Hepatitis C: Guide to Healthy Living.
Vaccination against hepatitis A and hepatitis B is essential for people with hepatitis C and HIV.
Preventing the spread of hepatitis C and HIV
Hepatitis C and HIV are both spread through blood-to-blood contact, therefore, transmission of both viruses can be prevented by being blood aware. HIV is also sexually transmitted and can be prevented through the use of condoms and safer sex.
Decisions around safer sex when someone has HIV/hepatitis C co-infection are likely to be very individual but should be based on reliable information. Using condoms may be the preferred option. However, some HIV positive people with HIV positive partners often choose not to use condoms. If an individual is having sex with someone who is HIV positive, but not hepatitis C positive, they may want to discuss some of the potential risks for the sexual transmission of hepatitis C with a doctor, and whether they need to use a condom or barrier protection.
Recent studies have reported a higher than expected prevalence of hepatitis C infections occurring in men with HIV, particularly in men who have sex with men. (Filippina. et.al, Ghosn. et.al & Serpaggi. et.al) If a man is co-infected with HIV and hepatitis C he may wish to avoid high risk sexual activities with multiple casual partners and where there is the potential for blood-to-blood contact including unprotected oral and anal sex.
Dore, G. & Sasadeusz, J. (Eds) (2006). Co-infection: HIV & Viral hepatitis a guide for clinical management. ASHM.
Filippini, P., Coppola, N., Scolastico, C. et al. (2001). 'Does HIV infection favour the sexual transmission of hepatitis C?'. Sexually Transmitted Diseases. Vol 28:725–729.
Ghosn, J., Pierre-Francois, S., Thibault, V. et al. 'Acute hepatitis C in HIV-infected men who have sex with men'. HIV Medicine 2004; 5:303–306.
Serpaggi, J., Chaix, M-L., Batisse, D. (2006) 'Sexually transmitted acute infection with a clustered genotype 4 hepatitis C virus in HIV-1 infected men and inefficiency of early antiviral therapy'. AIDS. 20:233–240.