HIV and Opportunistic Infections, Coinfections, and Conditions

Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). The abbreviation HCV can stand for either the virus or the infection it causes.

HCV can be either a short-term (acute) or a long-term (chronic) illness:

• Acute HCV occurs within 6 months after exposure. In most people, acute HCV becomes chronic HCV.
• Chronic HCV can last a lifetime. Without treatment, chronic HCV can cause liver cancer or severe liver damage that can lead to liver failure.
• HCV is a contagious infection that can spread from person to person.

HCV is spread mainly through contact with the blood of a person who has HCV. In the United States, HCV is spread mainly by sharing needles or other injection drug equipment (works) with someone who has HCV. HCV can also be spread through sexual contact. While the risk of transmission through sexual contact is low, the risk is increased in people with HIV.

Because both HIV and HCV can spread in blood, a major risk factor for both HIV and HCV infection is injection drug use. Sharing needles or other drug injection equipment increases the risk of contact with HIV- or HCV-infected blood.

According to the Centers for Disease Control and Prevention (CDC), approximately 21% of people with HIV in the United States also have HCV. Infection with both HIV and HCV is called HIV/HCV coinfection.

In people with HIV/HCV coinfection, HIV may cause chronic HCV to advance faster. Whether HCV causes HIV to advance faster is unclear.

The best protection against HCV is to never inject drugs. If you do inject drugs, always use new, sterile needles, and do not reuse or share needles, syringes, or other injection drug equipment.

People, including people with HIV, can also take the following steps to reduce their risk of HCV infection:

• Do not share toothbrushes, razors, or other personal items that may come in contact with another person’s blood.
• If you get a tattoo or body piercing, make sure the instruments used are sterile.
• Use condoms during sex. The risk of HCV infection through sexual contact is low, but the risk increases in people with HIV. Condoms also reduce the risk of HIV transmission and infection with other sexually transmitted diseases, such as gonorrhea and syphilis.

Every person who has HIV should get tested for HCV. Usually, a person will first get an HCV antibody test. This test checks for HCV antibodies in the blood. HCV antibodies are disease-fighting proteins that the body produces in response to HCV infection.

A positive result on an HCV antibody test means that the person has been exposed to HCV at some point in their life. However, a positive antibody test does not necessarily mean the person has HCV. For this reason, a positive result on an HCV antibody test must be confirmed by a second test. This follow-up test checks to see if HCV is present in the person’s blood. A positive result on this test confirms that a person has HCV.

Most people with acute HCV do not have symptoms. But some people can show signs of HCV soon after becoming infected. Symptoms of acute HCV can include the following:

• Fever
• Tiredness
• Loss of appetite
• Nausea
• Vomiting
• Abdominal pain
• Dark-colored urine
• Clay-colored bowel movements
• Joint pain
• Jaundice (yellowing of the skin or the whites of the eyes)

Most people with chronic HCV do not have any symptoms. Chronic HCV is often discovered based on results from routine liver function tests.

HCV is treated with antiviral medicines. Many newer HCV medicines are more effective and have fewer side effects than older medicines. The newer medicines can cure HCV in most people.

People with HIV/HCV coinfection may be treated for both infections. However, when to start each treatment and what medicines to take depends on the person. For example, some HIV and HCV medicines cannot be safely used together because of drug-drug interactions.

Health care providers prescribe HIV and HCV medicines carefully to avoid drug-drug interactions and closely monitor those taking the medicines for any side effects.

If you have HIV/HCV coinfection, talk to your health care provider about the best medicines for you.

From CDC:

• Clinical Overview of Hepatitis C
• Hepatitis C Basics
• Viral Hepatitis Among People With HIV

From the Department of Health and Human Services:

• Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV:
  • Hepatitis C Virus Infection
• Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV:
  • Hepatitis C Virus/HIV Coinfection

From the National Institute of Diabetes and Digestive and Kidney Diseases:

• Hepatitis C

Also see the HIV Source collection of HIV links and resources.