Hepatitis C

What is Hepatitis?

Hepatitis means inflammation of the liver. This condition is often caused by a virus.

In the United States, the most common causes of viral hepatitis are hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV). HBV and HCV are common among people who are at risk for or living with HIV; that’s because these viruses are transmitted in some of the same ways HIV is transmitted—through injection drug use and condomless sex. When someone is infected with both HIV and viral hepatitis, we say that they are “coinfected.”

Viral hepatitis progresses faster and causes more liver-related health problems among people with HIV than among those who do not have HIV. Although drug therapy has extended the life expectancy of people with HIV, liver disease—much of which is related to HCV and HBV—has become a leading cause of non-AIDS-related death among people living with HIV.

This page is about how hepatitis C affects people with HIV. For information about other types of viral hepatitis, see our related pages, Hepatitis A and Hepatitis B.

Hepatitis C and HIV

• About 25% of people living with HIV in the U.S. are coinfected with HCV, and about 80% of people with HIV who inject drugs also have HCV.
• HIV coinfection more than triples the risk for liver disease, liver failure, and liver-related death from HCV. Coinfection can also complicate the management of HIV infection.
• All people living with HIV should be tested for HCV.
• There is no vaccine for HCV, but treatment is available.
• Hepatitis C treatments can cure HCV and these treatments are improving, with fewer side effects and shorter length of treatment than in the past.

Hepatitis C is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver. It results from infection with HCV.

HCV is one of the most common coinfections associated with HIV. According to CDC, about 25% of people living with HIV in the United States are coinfected with HCV, and about 80% of people with HIV who inject drugs are coinfected with HCV.

Transmission

HCV is a hardy virus that can remain infectious for up to 6 weeks outside the body. It is most commonly transmitted through contact with the blood of an HCV-infected person, primarily through sharing contaminated needles, syringes, or other drug use equipment. Less commonly, it is transmitted through sexual contact with an HCV-infected person, birth to an HCV-infected mother, or needlesticks or other sharp-instrument injuries.

Testing

HIV/HCV coinfection more than triples your risk for liver disease, liver failure, and liver-related death from HCV. HIV/HCV coinfection can also complicate the management of your HIV infection. For this reason, HHS’ Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, HRSA’s Clinical Guide for HIV/AIDS Care, and the CDC recommend that all people living with HIV get tested for HCV. Also, if you are engaged in behaviors that put you at risk for HCV (see “Transmission” above), talk to your healthcare provider about periodic retesting to make sure you have not been exposed to the virus since your last test.

Testing is particularly important because chronic HCV is often “silent,” meaning that you can have the infection for decades without having symptoms or feeling sick. During that time, however, the virus is damaging your liver.

There are usually only two blood tests that need to be done to determine if you have chronic hepatitis C.

The first test your provider will perform is called an "antibody" test, to see if your body has developed antibodies to HCV. (Antibodies are particles your body makes to fight off infections.) This test is sometimes called an anti-HCV test. A positive antibody result means that, at some point in your life, you were exposed to the hepatitis C virus, and you developed antibodies to fight off the virus. (Another name for this antibody test is EIA.) But just having a positive antibody test does not mean you have chronic hepatitis C infection.

If your hepatitis C antibody test is positive, then your doctor will perform a second test to see if you still have the hepatitis C virus in your body. This test is called a hepatitis C viral load test (or RNA test). If this test is positive, you have chronic hepatitis C, and you may eventually have health problems from the virus.

Protecting Yourself from HAV

Because there is no vaccine for HCV, the best way to prevent HCV infection is to never inject illegal drugs or to stop injecting illegal drugs if you currently do so by getting into and staying in a drug treatment program. You can find a drug treatment program by using AIDS.gov’s HIV Testing and Care Services Locator. If you continue injecting drugs, always use new, sterile syringes and never reuse or share syringes, needles, water, or other drug preparation equipment (“works”).

If you are living with HIV, you also can lower your risk of contracting viral hepatitis and other bloodborne viruses by not sharing toothbrushes, razors, or other personal items that may come into contact with another person’s blood. Do not get tattoos or body piercings from an unlicensed facility or in an informal setting, which may use dirty needles or other instruments, as these can put you at risk for hepatitis infections.

Treatment

If your hepatitis C test is positive, your healthcare provider will discuss treatment for this coinfection with you. HCV can be treated with antiviral medications. Many people infected with HCV experience a cure or clearance of the virus as a result of treatment. Most people would benefit from HCV treatment, so talk with your healthcare provider to find out whether treatment is recommended for you. Newly approved HCV treatments are available that are taken for a shorter period of time, have fewer side effects, and are more effective than treatments used in the past. Studies have demonstrated that these new treatments are effective in curing HCV in people living with HIV.  Treatment can be complex, so if you have HIV/HCV coinfection, you should look for a healthcare provider with expertise managing both infections.

If you have HIV/HCV coinfection, you should also ask your healthcare provider if you need to be immunized against HAV and HBV to prevent further infections and liver damage, and ask about other lifestyle changes you may need to make, such as avoiding the use of alcohol, as this can cause additional liver damage. You should also check with your healthcare provider before taking any prescription pills, supplements, or over-the-counter medicines, as these can potentially damage your liver.

Preventing the Spread of HCV to Others

If you are HIV-positive and coinfected with HCV, it is important to remember that the use of latex condoms not only reduces your risk of transmitting HIV and other STDs to sexual partners but reduces the risk of transmitting viral hepatitis infections as well.  In addition, because HCV is transmitted from infected person to uninfected person through blood and bodily fluids, be sure to avoid sharing needles, razors, and toothbrushes so that you do not pass HCV to others.

Learn More

For more information about HCV, see CDC’s Hepatitis C Information for the Public. Also see the Department of Veterans Affairs’ Hepatitis C and HIV Coinfection.

Also, CDC offers 5-minute online Hepatitis Risk Assessment Tool. This tool allows people to answer questions privately and get tailored recommendations based on CDC’s guidelines to discuss with their doctor.