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Hepatitis C and HIV Co-Infection

Reviewed by: HU Medical Review Board | Last reviewed: February 2022

Hepatitis C virus (HCV) can occur alongside many other conditions. One of these is the human immunodeficiency virus (HIV). About 20 percent or more of people with HIV also have HCV. Across the world, more than 2 million people are thought to have both HCV and HIV. This is called co-infection.1-3

What is HIV?

Like HCV, HIV is transmitted through contact with infected blood. HIV is also transmitted during sex. It can travel through vaginal fluids, rectal fluids, and semen.2-5

HIV affects white blood cells called CD4 T cells. These cells help fight germs and other invaders. As HIV continues to progress, CD4 counts can become very low. Over time, a person can no longer fight off infections. This continues for several years until a person develops acquired immunodeficiency syndrome (AIDS). AIDS can be life-threatening.3,4

How are HCV and HIV connected?

As mentioned, both HCV and HIV can be spread through contact with infected blood. Because of this, there are similar risk factors for both. One risk factor is injecting drugs. However, this is not the only way for a person to get both HCV and HIV. Any situation that leads to either virus being transmitted can lead to co-infection. For example, a person could get HCV from a blood transfusion in the 1980s and HIV from unprotected sex.2-4,6

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It is also possible for both HIV and HCV to be transmitted at the same time. The presence of HIV in the blood actually makes it more likely that HCV will be transmitted. This is also true for transmissions from mother to baby. A mother who has both HIV and HCV is more likely to transmit HCV to her baby.6

Health effects of having HCV and HIV together

HCV and HIV co-infection can lead to serious health issues. Although experts are not sure why, a person who has both infections is more likely to have severe liver damage. In addition, having HIV and HCV at the same time makes it less likely that a person will clear HCV on their own without treatment.2,3,6

Having both HIV and HCV can also increase the risk of other health issues. These include:3,7,8

  • Kidney disease
  • Neurological issues
  • Heart disease
  • Diabetes
  • Bone issues

The increased risk may be related to direct effects from the viruses or the treatments used to keep them under control.3

Signs of HIV

A person can have HIV for years without knowing it. Some may have minor flu-like symptoms when they first get the virus. These symptoms include:4

  • Fatigue
  • Muscle aches
  • Sore throat
  • Headache
  • Stomach upset
  • Rash

However, many people with HIV will not have symptoms until the virus has progressed. In some cases, a person might not know they have HIV until they develop a severe infection or AIDS. This is why getting tested for HIV, like getting tested for HCV, is so important.4

Treating HIV and HCV co-infection

HIV is treated with antiretroviral therapy (ART). These drugs reduce the amount of HIV virus in the blood. It is possible for the amount of HIV a person has to be undetectable. However, we do not have a complete cure for HIV at this time.2,4

In order to prevent complications from HIV and HCV, experts often recommend treating both viruses at the same time. This includes direct-acting antiviral drugs (DAAs) for HCV and ART for HIV. DAAs can be stopped if a person is cured of their HCV. ART for HIV needs to be continued for life.4,5

DAAs and ART drugs can interact with one another. They also have side effects. Your doctor can help determine which combination of drugs is best for your situation. The doctor will also monitor you for any issues resulting from treatment.4


Like with HCV, preventing HIV (or HCV and HIV co-infection) starts with good risk reduction behaviors. Examples include not sharing injection drug equipment and using barrier protection during sex.3,4

You can also get tested for HIV and HCV if you think you are at risk or have been exposed. Talk with your doctor or local health department if you are unsure about your specific risk or testing options.3,4

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The HepatitisC.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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