HCV/HIV Coinfection

Hepatitis C virus is also known as HCV. HCV is a liver disease that, over time, can lead to severe scar development (fibrosis and cirrhosis).

HIV (human immunodeficiency virus) is a virus that attacks the body’s immune system.  Without treatment, HIV can progress to AIDS (acquired immunodeficiency syndrome). 

HCV/HIV coinfection means that a person has both viruses at the same time. For every 100 people with HIV, approximately 21 of them also have HCV. (Centers for Disease Control and Prevention, 2021)

Risks for HCV Infection

HCV is spread through blood-to-blood contact. This means that if someone else’s blood enters your body (even in a small amount), you can be infected if that person is infected.  Remember:  HCV often has no symptoms, so people may have the infection but not know it. For more information about risks for HCV, testing, and treatment, visit https://liverfoundation.org/liver-diseases/viral-hepatitis/hepatitis-c/.

Risks for HIV Infection

HIV, like HCV, can spread through blood contact. The difference is that HIV can also spread from person to person through the following body fluids:

  • Blood
  • Semen and pre-seminal fluids
  • Rectal fluids
  • Vaginal fluids
  • Breast milk

For these fluids to infect someone with HIV, they must enter the body through the bloodstream (such as via injection), or through mucus membranes or damaged body tissues. To learn more about HIV infection, including transmission risks, visit https://www.cdc.gov/hiv/basics/transmission.html.


Most people with HCV do not have symptoms, sometimes for years.  People with HIV often do develop symptoms within a month of being infected.

If symptoms occur with HCV, they can include:

  • Feeling very tired (fatigue)
  • Fever
  • Tenderness or pain in the upper right part of their abdomen
  • Nausea
  • Loss of appetite
  • Weight loss
  • Jaundice (yellowing of skin and whites of the eyes)

Symptoms of HIV can include:

  • Headache
  • Fever
  • Muscle aches
  • Night sweats
  • Diarrhea
  • Sores in the mouth or yeast infections in the mouth (thrush)
  • Swelling of the lymph glands

The only way to know for sure if you have HCV and/or HIV is to get tested. Blood tests will determine if you have HCV, HIV, or both.

How does having HIV affect the HCV infection?

Having HCV alone can cause serious liver damage over time. Damage can include liver inflammation (swelling), early scar formation (fibrosis), and advanced scarring of the liver (cirrhosis).  People with long-term (chronic) HCV are at risk for developing liver cancer.

If someone has HIV and HCV, the HIV may cause the HCV to progress at a faster rate than if the person had only HCV.  We do not yet know if having HCV can cause HIV to advance at a faster rate.

Treating HCV/HIV Coinfection

HCV is now a curable disease. HIV does not have a cure, but with proper treatment and management, it is possible to prevent HIV from progressing to AIDS.

People with HCV/HIV coinfection can be treated for both diseases at the same time. Consideration will be given to prescribing a treatment plan with as few drug interactions as possible so that patients will experience the most positive results possible.

HCV is treated with drugs called Direct Acting Antivirals (DAAs). These DAAs prevent the HCV virus from multiplying in the body. Most people with HCV can take DAAs. There are a few different DAAs being used to treat HCV. They are in pill form, and treatment is usually completed within three months.  Your doctor will be able to provide information about which specific DAA is best for you.

HIV is treated using antiretroviral therapy (ART). ART consists of a combination of medicines which must be taken every day. These medicines keep people with HIV healthier for longer periods of time, can reduce HIV transmission,

Doctors and their patients will discuss exactly how to take the HCV and HIV medications. Healthcare providers will also review any possible drug interactions, side effects and ways to manage side effects, and how often patients should be seen while undergoing treatment. Blood tests are taken throughout treatment to measure viral load (amount of virus) present in the body.

For people with HCV, doctors will discuss tests that may be required to check the condition of their livers (ultrasound, MRI, CT scans) and how often those tests are needed.

If cirrhosis is present, talk to your healthcare provider about being screened for liver cancer at least twice a year.

Tips to Live Healthfully

Some important ways to help your body when you have a chronic illness include:

  • Eat foods that are nutritious (fruits, vegetables, lean proteins vs. red meat, whole grains). Try to avoid processed foods, which tend to be higher in salt, sugars and preservatives.
  • Avoid alcohol in the presence of any liver disease because alcohol can speed up liver damage.
  • Do not take any medicines or supplements without discussing them with your healthcare provider first. Some products, even “natural” ones, can interact badly with your HCV and/or HIV medicines.
  • Be careful about using medicines that contain acetaminophen (such as Tylenol). Acetaminophen can be harmful to the liver in large doses or if liver disease is already present.
  • Take your HCV and HIV medicines exactly as directed by your healthcare provider.
  • Talk to your healthcare provider about getting vaccinated for hepatitis A and B so that you are not at risk for additional viral hepatitis infections other than HCV.

Questions to Ask the Doctor

  • What medical tests do I need to find out about my viral load?
  • What medical tests do I need to check on the condition of my liver?
  • How often will I need to get blood tests or other tests to monitor my health? Which tests are needed to monitor HCV, and which are needed to monitor HIV?
  • Which HCV medication do you recommend for me?
  • How long will I have to take the HCV medication?
  • Which HIV medications do you recommend for me?
  • What do I need to know about the side effects of my medications?
  • What possible drug interactions are possible when I take the HCV and HIV medicines?
  • Are there any vitamins that I should take or avoid?
  • Do you have any information about diet that will be helpful for me?
  • If I am cured of HCV, will any liver damage that I have go away?
  • Am I at risk for liver cancer after being infected with HCV and/or coinfected with HIV? How often should I be screened for liver cancer?
  • Do you know of any support groups in this area for people with HCV and HIV?
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