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Hepatitis C and HIV Co-infection


Co-infection with hepatitis C and HIV means that a person has both the hepatitis C virus and the human immunodeficiency virus (HIV) – the virus responsible for acquired immune deficiency syndrome (AIDS). People with HIV often have HCV. Nearly all persons with hemophilia and HIV are co-infected because blood products transmitted both viruses. Having HIV increases the risk of getting symptoms and serious liver disease sooner. This might happen because HIV decreases the immune response thereby letting HCV progress more easily.

Is HCV treatment different if I am co-infected?


  • Treatment for HCV is only effective if the HIV is under good control. Generally, good control of HIV is considered to be when blood tests show a CD4 (a surface antigen on helper T-cells very important for resisting viruses) count over 250 and a low or undetectable HIV viral load.
  • People who are co-infected have a delayed response to interferon. Your doctor will likely try to measure the effectiveness of treatment by seeing if you have achieved a response (negative HCV RNA) to the HCV treatment after twelve weeks of therapy.
  • Persons with AIDS are more susceptible to infections. Since interferon lowers the count of white blood cells, unusual bacterial infections may occur when on treatment for HCV.
  • Some anti-HIV drugs may cause liver damage. The negative effects on the liver will usually go away if the drug is stopped or the dose is lowered. The least liverfriendly anti-HIV drugs may be ritonavir, d4t/stavudine, and nevirapine.
  • For people with hemophilia who are co-infected, the dosage for certain HIV drug combinations requires careful individualized assessment to avoid drug toxicity.

What about liver transplantation?


In the past, people with HIV and HCV were not considered for liver transplants. However, this has changed.

  • Seek the opinion of your local transplant centre.
  • Clinical Trials: The Canadian Hemophilia Society (CHS) can provide co-infected persons (who have their HIV under control) with information on Trial Protocols involving liver transplantation and how to contact the doctors involved.
  • Transplantation in the United States: The cost of a liver transplant in the United States is significant, at approximately $200,000 U.S. at time of publication.

What should I do if I am co-infected?


  • Discuss the potential risk of combinations of drugs with your health care provider and pharmacist.
  • Have your enzyme levels checked regularly.