HIV and Hepatitis C Co-Infection

By Lucy Gleysteen

From PHN Issue 35, Winter 2018

Finding out that you have both HIV and hepatitis C can be difficult. Some people can be living with HIV and/or hepatitis C and not know their status because it sometimes takes a long time for symptoms to appear. If you think you might have contracted HIV or hepatitis C, you can ask your doctor to provide testing. According to the US Department of Health and Human Services guidelines, prisons should provide testing.

What is HIV/hepatitis C co-infection?

Co-infection means that a person is living with more than one virus. According to the Centers for Disease Control and Prevention, one-third of people living with HIV in the United States have either hepatitis B virus or hepatitis C virus. This is because hepatitis B and C and HIV have some overlap in their modes of transmission. For those living with HIV who also inject drugs, the rate of having both HIV and hepatitis C is higher.

How does co-infection happen?

Both HIV and hepatitis C can be transmitted through blood. In both cases, a virus lives in the blood, and that virus can be transferred from one person to another. While HIV cannot survive for very long outside of the body, the hepatitis C virus can live outside the body for up to three weeks. The hepatitis C virus can survive in dried blood, even if it is in tattoo ink or on a needle or other injection equipment. People who are incarcerated are at greater risk for hepatitis C, because many people in jail or prison already have it. The most common ways that people get hepatitis C in prison are through injecting drugs, tattooing, or piercing. To prevent hepatitis C transmission, try to avoid sharing needles, cookers, cottons, ties, water used for drugs or ink, needles, or barrels that have been used by anyone else. If there is blood on any of these objects, it is usually too small to see. Bleaching, boiling, heating with a flame, using cleaning supplies, alcohol, or peroxide are not strong enough to kill the hepatitis C virus.

HIV is transmitted only through certain body fluids, including blood, semen (cum), pre-cum, vaginal fluids, and breast milk. The most common forms of transmission are through anal or vaginal sex and by sharing needles or syringes. In order to have a co-infection, you must have contracted both HIV and hepatitis C.

How does the combination of HIV and Hepatitis C impact someone’s health?

People living with both HIV and hepatitis C are at greater risk for developing serious medical conditions, including an increased risk for developing chronic hepatitis. This is because those who are living with HIV and hepatitis C are more likely to have the virus progress at a faster rate. This is likely to cause liver-related health problems. Living with HIV and hepatitis C may also complicate the treatment of HIV. It is recommended that those living with HIV should get tested for hepatitis B and C. HIV and hepatitis C can be effectively treated in most people.

Considerations for Starting Treatment

How should I start to prepare for hepatitis C treatment?

Starting treatment for both hepatitis C and HIV can be a big step. In order for the drugs to work, it is important to take them on the schedule your doctor prescribes. Hepatitis C can be cured. The body is more likely to clear hepatitis C if you take all of the doses. There is currently no cure for HIV, but it can be effectively treated. By taking HIV medications as prescribed, the virus will stay suppressed. Missing doses gives HIV the opportunity to strengthen and take more control in the body.

What does this mean for my HIV treatment?

It is not recommended to stop HIV treatment when you start treatment for hepatitis C. Antiretroviral therapy can even slow the progression of liver disease, because it helps restore immune functioning.

What about drug interference?

It might be helpful to ask to your doctor to find out if any of the HIV meds you take negatively impact the progression of hepatitis C liver disease. Hepatitis C treatment regimens should be selected with special consideration for how different medications interact with each other.

What type of test needs to be done before treatment?

According to the National Institutes of Health, all individuals living with HIV and hepatitis C should be evaluated for hepatitis C treatment. If you have both HIV and hepatitis C, you can ask your doctor for a liver fibrosis stage assessment, because it informs treatment. People living with HIV and hepatitis C should also be screened for the hepatitis B virus.

What about side effects?

Hepatitis C treatment with the new direct-acting antivirals has very few side effects. When side effects are reported, they are generally mild and rarely involve stopping treatment. Those living with HIV might experience symptoms at a slightly greater intensity. This includes fatigue, headache, nausea, diarrhea, insomnia, and weakness.

What else impacts treatment?

The rate at which hepatitis C affects the body is impacted by age, alcohol consumption, and amount of time since transmission. The progression of hepatitis C will impact your ability to obtain treatment within prison or jail. Even though it is recommended that all people receive treatment for hepatitis C, your ability to obtain treatment is impacted by how far along hepatitis C has progressed. It is the standard of care that everyone who has chronic hepatitis C must get treatment. It is unfair and unconstitutional that many prisons only reserve treatment for those whose hepatitis C has progressed far.

Is there special consideration given to those living with both HIV and hepatitis C?

There is no evidence that people living with both HIV and hepatitis C are more likely to get treatment in prison than those with one virus.

How else can I take care of my health?

There are some things that you can do to protect your liver health. These include getting enough rest, exercising, eating healthy foods, and avoiding alcohol and smoking. It is also important to take care of your mental health. Different people find different things helpful, but some people take care of their mental health by talking to someone they trust, getting exercise, writing in a journal, doing art, and/or talking to a counselor.

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