What is coinfection?
Coinfection happens when you have 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 liver diseases. Liver diseases account for 14 to 18 percent of deaths in people with HIV. Of those liver diseases, 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.
How do you contract hepatitis C?
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. You’re most likely to contract it from blood that contains the virus. For example, needle sticks, sharing needles, and getting tattoos puts you at risk of contracting hepatitis C.
You can also contract it by having unprotected sex with someone who has a hepatitis C infection. If you’ve had a blood transfusion before 1992 or a clotting factor transfusion before 1987 you’re also at risk. Unlike hepatitis A and B, there’s no vaccine available for hepatitis C.
What are the risks of coinfection?
Since HIV affects your immune system, a hepatitis C infection may progress faster toward liver damage. It’s also less likely for an acute hepatitis C infection to clear up on its own. People with a HIV/HCV coinfection have a higher risk for:
- liver-related complications
- hepatic fibrosis and cirrhosis, or excessive connective tissue buildup in the liver
- liver failure
If you’ve been diagnosed with HIV, your doctor may prescribe highly active antiretroviral therapy (HAART). HAART can help keep your HIV infection under control, but some of these medications can cause liver problems, especially in patients coinfected with hepatitis C.
This doesn’t mean you should stop your HIV treatment. In fact, the benefits of HAART in patients with coinfection have been shown to outweigh the risks. Your doctor will monitor your liver function while you’re on HAART.
One study showed that people with a 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.
The importance of testing
Hepatitis C testing
If you have HIV, it’s a good idea to undergo regular testing for hepatitis C. Experts recommend everyone with an HIV infection get tested for hepatitis C. It’s especially important to see if cirrhosis, or liver scarring, has developed. Your doctor should also go over the risk factors for hepatitis C. This can help determine how frequently you need to get tested.
If you suspect you’ve been exposed to hepatitis C, you may need multiple tests to learn if you have an infection. A hepatitis C virus may not show up in your blood tests for several months.
Hepatitis C symptoms often go unnoticed until the virus has already caused serious liver damage. This makes a HCV infection difficult to recognize in its early stages. When someone has HIV, hepatitis C is particularly life-threatening because HIV weakens your immune system. This makes it harder for your body to fight off the infection.
HIV viral load and CD4 count
Some hepatitis C treatments may interfere with your 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.
An HIV/HCV coinfection can also interfere with HIV treatment. Each person will have a different regimen to treat a HIV/HCV coinfection. Your doctor will work with you to figure out an individual treatment plan based on:
- how much liver damage there is
- the type of liver damage you’re at risk for
- your reaction to medications
- your overall health
- whether you’re pregnant
The standard treatment for hepatitis C is less effective for people with HIV, and some medications can increase your risk for liver failure. Your doctor will also recommend limiting alcohol consumption as alcohol can speed the progression of liver damage.
Work with an HIV expert to adjust your medications. Your hepatitis C treatment shouldn’t be shorter than 12 weeks. There are some drugs or therapies that shouldn’t be used together, such as:
- elbasvir/grazoprevir with HIV protease inhibitors like cobicistat, efavirenz
- 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 your risk for anemia, liver toxicity, and liver failure. You can read more about current regimen recommendations at HCV Guidance.
How to lower your risks for a HCV infection
It’s important to take steps to avoid getting infections, especially if you have HIV. HIV weakens your immune system and makes recovery more difficult.
The best way to prevent a HIV/HCV coinfection is to:
- avoid unprotected sex
- avoid sharing needles
- avoid using recreational drugs
- use your own toothbrush and shaving razor
- get regularly tested and treated for sexually transmitted infections if you’re in a high risk sexual group
Taking preventive measures can help prolong and improve your 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.