Hepatitis C is a contagious viral infection that affects the liver. People living with HIV may be at a higher risk of contracting hepatitis C as the two conditions have similar mechanisms of transmission.

Both hepatitis C and HIV are bloodborne viruses. This means that people can carry these viruses in their blood and may acquire an infection following exposure to blood or other bodily fluids containing the virus. Hepatitis C is a liver disease that can lead to severe liver problems. HIV is a virus that targets the immune system and weakens the body’s ability to fight off infections.

As HIV makes people more susceptible to infections, and people can acquire the hepatitis C virus (HCV) and HIV in similar ways, it is not uncommon for people to have a coinfection, where both infections are active at the same time. If left untreated, HCV can cause severe complications in people living with HIV. However, effective treatment options are available for both conditions, and people living with HIV can have similar HCV cure rates as HIV-negative individuals.

In this article, we discuss the relationship between hepatitis C and HIV. We also cover symptoms, prevention, and treatment for hepatitis C.

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Hepatitis C results from infection with HCV and causes inflammation of the liver. Many people may acquire HCV by sharing needles or other equipment to prepare and inject drugs.

Evidence estimates that during 2013–2016, roughly 2.4 million people in the United States were living with hepatitis C. The Viral Hepatitis Surveillance Report estimates that roughly 57,500 acute hepatitis C cases occurred in 2019.

For some people, hepatitis C can be a short-term illness, but it becomes a chronic infection in most cases. Acute hepatitis C usually develops within 6 months of contracting the virus. More than 50% of HCV infection cases progress to the chronic form. If left untreated, chronic hepatitis C can lead to serious, even life threatening health problems, such as liver cirrhosis, hepatic fibrosis, or hepatocellular carcinoma, which is a type of liver cancer.

HIV is a virus that weakens the immune system by destroying important cells that prevent disease and infection.

The most common ways people acquire HIV in the U.S. are through sexual contact or sharing injection drug equipment. According to the Centers for Disease Control and Prevention (CDC), roughly 1,189,700 people in the U.S. were living with HIV at the end of 2019. Data also suggest that approximately 36,801 people in the U.S. received an HIV diagnosis that year.

Without treatment, an HIV infection typically progresses through three stages: acute infection, chronic infection, and stage 3 infection, also known as AIDS. As HIV weakens the immune system, people become more likely to experience complications, such as opportunistic infections and coinfections.

Both HCV and HIV are bloodborne viruses that people can acquire from sharing injection drug equipment. Although sexual transmission of HCV is less common than the sexual transmission of HIV, it can happen if there is direct exposure to blood containing HCV.

A potential complication of HIV is a coinfection. This describes when more than one infection is active at the same time. Evidence indicates that roughly 21% of people living with HIV in the U.S. also have HCV. Other data suggests that approximately 4% of people with HCV have coinfection with HIV. Globally, nearly 2.3 million people are living with an HIV-HCV coinfection.

However, these rates can vary significantly depending on an individual’s risk factors. A 2016 systematic review suggests that people living with HIV were six times more likely to have hepatitis C than people without HIV. Additionally, the CDC notes that HIV-HCV coinfection occurs in 62–80% of people with HIV who use injection drugs.

Chronic liver disease represents a major cause of death among those living with HIV globally. A 2019 study indicates that an HIV-HCV coinfection is associated with a threefold higher risk of death compared with those with an HIV-monoinfection and 12 times higher than the general population.

People living with HIV are at risk of developing coinfections such as hepatitis C because HIV weakens the immune system, leaving the body more susceptible to other infections and illnesses. As a result, the body is also less able to fight off HCV. This means that complications may occur sooner and develop at a younger age in individuals with an HIV-HCV coinfection.

Hepatitis C infections are more serious in people with HIV and can lead to more severe damage to the liver. HIV and HCV coinfections can increase the risk of:

As such, it is highly advisable that people living with HIV screen for HCV infection, particularly if they are at high risk or suspect HCV infection.

Most people who have acute hepatitis C do not experience symptoms. If symptoms do appear, they can include:

The majority of people with chronic hepatitis C either show no symptoms or have symptoms resembling those of other conditions. People with chronic hepatitis C can develop liver damage that ranges from mild to severe. However, the condition often progresses slowly, and symptoms of liver damage can develop gradually over years or even decades.

Symptoms of chronic hepatitis C can include cirrhosis, fatigue, and depression. Cirrhosis is scarring of the liver and can lead to:

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A person can contract HCV through direct contact with blood or other body fluids that contain the virus. Possible modes of transmission include:

  • using unsterilized needles or syringes
  • using unsterilized tattoo or body piercing equipment
  • needlestick injuries in healthcare and laboratory settings
  • sharing toothbrushes, razors, or any other objects that could have blood on them
  • having sexual intercourse without using a condom, although this type of transmission very rare

There is also a small risk that people can transmit HCV to a fetus during pregnancy. According to the American College of Obstetricians and Gynecologists, about 4% of pregnant people with hepatitis C transmit the infection to the fetus. Having larger amounts of HCV in the blood or an HIV coinfection increases the risk of transmission.

Currently, there is no vaccine available for hepatitis C. As such, the best way to avoid acquiring HCV is to avoid behaviors that can transmit the virus, such as injecting drugs.

People living with HIV may consider having regular tests for hepatitis C. Often, hepatitis C does not lead to symptoms until the virus has caused serious liver damage. The condition is difficult to recognize in the acute phase, so testing is important.

Ways to prevent hepatitis C can include:

  • avoiding sharing needles
  • avoiding sharing personal hygiene items, such as toothbrushes and shaving razors
  • only using qualified and reputable practitioners for tattoos and piercings
  • using condoms during sex

Unlike hepatitis A and B, there is currently no vaccine available for hepatitis C. However, both acute and chronic hepatitis C infections are curable.

Current hepatitis C treatments involve taking two or more medications known as direct-acting antiviral agents (DAAs). This combination of medications prevents HCV from replicating until the virus is no longer present in the body. Treatment usually takes 8–24 weeks but can take longer.

However, people who have both HIV and HCV need individualized treatments because the medications used to treat HCV infections can interact with HIV treatments.

A doctor will recommend a treatment plan based on different factors, such as the individual’s:

  • hepatitis C genotype
  • amount and extent of liver damage
  • current medications

Without treatment, HIV-HCV coinfection can result in much less positive outcomes compared with HIV monoinfection. However, the use of DAAs for HCV and antiretroviral therapy for HIV can help to cure and control the conditions, respectively. A 2020 study notes that 94% of people with an HIV-HCV coinfection receiving DAA treatment achieved undetectable levels of HCV in their blood.

People with HIV are at higher risk of acquiring hepatitis C than those without HIV. As HIV affects the immune system, people are vulnerable to complications such as a coinfection of both HIV and hepatitis C.

A person can acquire hepatitis C through direct contact with blood containing HCV. Risk factors for hepatitis C include sharing needles or personal hygiene items and a low risk of contracting HCV through sex without a condom.

Hepatitis C can cause severe complications, and symptoms often take years to develop. As such, it is highly advisable for individuals living with HIV to regularly screen for HCV to allow for early detection and treatment. Hepatitis C is curable, but treatment is more complex in people living with HIV, as HCV medications can interact with HIV treatment.