Hepatitis C and HIV co-infection

About 13% of people in Australia living with HIV are estimated to also have hepatitis C.  It can happen that a person living with HIV may not know they are co-infected with either hepatitis B or C unless they are tested specifically for these viruses. This can require PCR testing (detects the virus) rather than Antibody testing which is more commonly used.  

Because of shared risk factors for transmission, both hepatitis C and B are more common in people living with HIV than in the general population.

People who share injecting equipment are at increased risk for hepatitis C and HIV co-infection, while unsafe sexual practices are responsible for most cases of HIV-hepatitis B co-infections.

Because HIV decreases the effectiveness of immune responses it can worsen hepatitis C-related liver disease, leading to more rapid progression to cirrhosis and to earlier development of liver cancer.  It is unclear what impact, if any, hepatitis C has on the progression of HIV.

Testing for hepatitis C and HIV

Blood testing will detect hepatitis C and/or HIV infection.  In some cases of co-infection the results of the first blood test for hepatitis C may be unclear or even show a negative result. This can happen because HIV may slow or prevent the development of hepatitis C virus antibodies or even decreasing existing antibodies. It may be necessary to have PCR testing which specifically looks for the hepatitis C virus in order to make an accurate diagnosis.  If risks for contracting hepatitis C are ongoing, then such testing may need to be on a regular basis.

Co-infection with hepatitis C and HIV requires regular blood tests and viral load tests to track disease progression and it is strongly recommended that anyone with co-infection find a doctor experienced in both hepatitis C and HIV. Any AIDS Council or Hepatitis Council can suggest appropriate doctors or clinics.  

Treatment of HIV/hepatitis C co-infection

Effective treatment is available for both hepatitis C and HIV and, in the case of co-infection, treatment decisions are made on a case-by-case basis.  Treatment is potentially more complicated with co-infection and certainly needs to be monitored closely.  Study results show that hepatitis C treatment in people living with HIV is effective, although at a reduced rate to those with hepatitis C only and there appears to be a higher rate of HCV treatment cessation in due to side effects.  The presence of hepatitis C may affect HIV treatment choices as some HIV drugs impact on the liver.  There is, however, no ‘best HIV treatments’ list in these cases; however avoiding nevirapine, full dose ritonavir and timpranavir is important.  Specialised care is important in cases of hepatitis C and HIV coinfection.

Vaccination against both hepatitis A and B is essential for people living with hepatitis C and HIV co-infection.

Prevention

Being blood aware is important as both hepatitis C and HIV are transmitted through blood-to-blood contact.  While HIV is also sexually transmitted, it is uncommon for sexual transmission of hepatitis C to occur.  However, the presence of HIV increases the risk of sexual transmission of hepatitis C.  While decisions around safer sex practices are very individual care should be taken to consider the risks and obtain reliable information on which to base such decisions.  Information on risk education is available from Hepatitis Councils and HIV/AIDS Councils around Australia.

References

This information was adapted from the Hepatitis Australia website.

Dore, G. & Sasadeusz, J. (Eds) (2006). Coinfection: HIV & Viral hepatitis a guide for clinical management. ASHM.

Filippini, P., Coppola, N., Scolastico, C. et al. Does HIV infection favour the sexual transmission of hepatitis C? Sexually Transmitted Diseases 2001; 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. Sexually transmitted acute infection with a clustered genotype 4 hepatitis C virus in HIV-1 infected men and inefficiency of early antiviral therapy. AIDS 2006; 20:233–240.

Crockett, S.D. and Keeffe, E.B. Natural history and treatment of hepatitis B virus and hepatitis C virus coinfection. Annals of Clinical Microbiology and Antimicrobials 2005: http://www.ann-clinmicrob.com/contents/4/1/13.

Liu, C.J., Chen, P.J., Lai, M.Y. et al. (2003). Ribavirin and interferon is effective for hepatitis C virus clearance in hepatitis B and C dually infected patients. Hepatology. 37: 568-567.

Page last updated: Wednesday 15 September, 2010