Coinfection happens when a person has two infections at once. When someone has the human immunodeficiency virus (HIV), their body’s immune system is weaker, making it easier to contract other infections such as pneumonia and certain liver diseases. Complications from liver disease account for 14 to 18 percent of deaths in people with HIV. Of those infections causing liver disease, hepatitis C is one of the most common.

According to the Centers for Disease Control and Prevention (CDC), about 25 percent of people with HIV in the United States also have hepatitis C. Both viruses are life-threatening, especially when left untreated. Read on to learn more about the risks for these viruses and what to do.

Coinfection of HIV and hepatitis C (HIV/HCV coinfection) is relatively common. In people who contracted HIV from intravenous drug use, the coinfection rate is 50 to 90 percent. People are most likely to contract it from blood that contains the virus. For example, needle sticks, sharing needles, and getting tattoos puts one at risk of contracting hepatitis C.

One can also contract it by having sex without a condom with someone who has a hepatitis C infection. People who had a blood transfusion before 1992 or a clotting factor transfusion before 1987 are also at risk. Unlike hepatitis A and B, there’s no vaccine available for hepatitis C.

Since HIV affects the immune system, a hepatitis C infection may progress faster toward liver damage. A hepatitis C infection is also less likely to clear up on its own. People with a HIV/HCV coinfection have a higher risk for:

  • hepatic fibrosis and cirrhosis, or excessive connective tissue buildup in the liver
  • complications of chronic liver dysfunction
  • liver failure
  • mortality

If a person has been diagnosed with HIV, their doctor may prescribe highly active antiretroviral therapy (HAART). HAART can help keep HIV under control, but some of these medications can cause liver problems, especially in patients with a hepatitis C coinfection.

This doesn’t mean anyone should stop their HIV treatment. In fact, the benefits of HAART in patients with coinfection have been shown to outweigh the risks. A healthcare provider will monitor a person’s liver function while they’re on HAART.

One study showed that people with an HIV/HCV coinfection and an undetectable HIV viral load had a slower fibrosis progression. Another 2016 study found that people with an HIV/HCV coinfection who took combined antiretroviral therapy (cART) had decreased levels of hepatitis C virus over time.

Hepatitis C testing

It’s a good idea for people living with HIV to undergo regular testing for hepatitis C. Experts recommend that everyone diagnosed with HIV get tested for hepatitis C. It’s especially important to see if cirrhosis, or liver scarring, has developed. The doctor should also go over the risk factors for hepatitis C. This can help people determine how frequently they need to get tested.

If a person suspects they’ve been exposed to hepatitis C, they may need multiple tests to learn if they have an infection. A hepatitis C virus may not show up in blood tests for several months.

Hepatitis C symptoms often go unnoticed until the virus has already caused serious liver damage. This makes an HCV infection difficult to recognize in its early stages. When someone has HIV, hepatitis C is particularly dangerous because HIV weakens the immune system. This makes it harder for the body to fight off the infection.

HIV viral load and CD4 count

Some hepatitis C treatments may interfere with HIV treatment. One study found that acute hepatitis C treatment temporarily decreased the CD4 count and increased the viral load of people with HIV/HCV coinfections. This change in levels can increase risk of HIV transmission.

Individualized treatment

An HIV/HCV coinfection can also interfere with HIV treatment. Each person will have a different regimen to treat an HIV/HCV coinfection. The doctor will work with the individual to figure out a personal treatment plan based on:

  • how much liver damage there is
  • the type of liver damage they’re at risk for
  • their reaction to medications
  • their overall health
  • whether they’re pregnant

The standard treatment for hepatitis C is less effective for people with HIV, and some medications can increase risk for liver failure. A doctor will also recommend limiting alcohol consumption as alcohol can speed the progression of liver damage.

Work with an HIV expert to adjust medications. Hepatitis C treatment shouldn’t be shorter than 8 weeks. There are some drugs or therapies that shouldn’t be used together, such as:

  • elbasvir/grazoprevir with HIV protease inhibitors like atazanavir, darunavir, or lopinavir
  • sofosbuvir-based regimens with tipranavir
  • sofosbuvir/velpatasvir with efavirenz, etravirine, or nevirapine
  • ribavirin with didanosine, stavudine, or zidovudine

Some of these drug combinations can increase the risk for anemia, liver toxicity, and liver failure. You can read more about current regimen recommendations at HCV Guidance.

It’s important to take steps to avoid getting infections, especially people living with HIV. HIV weakens the immune system and makes recovery more difficult.

The best way to prevent a HIV/HCV coinfection is to:

  • avoid sex without a condom
  • avoid sharing needles
  • avoid using recreational drugs
  • use one’s own toothbrush and shaving razor
  • get regularly tested and treated for sexually transmitted infections

Taking preventive measures can help prolong and improve one’s quality of life. Talk to your doctor if you have concerns about an HIV/HCV infection. Early treatment of acute hepatitis C is associated with improved response rates. While having an HIV/HCV coinfection requires more attention, it’s a survivable condition.