Co-infection with HIV

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Approximately 10,000 people in Canada are co-infected with the human immunodeficiency virus (HIV) and the hepatitis C virus (HCV). Although these numbers are based on estimates and predictions, it does mean that about 20% of people living with HIV are also living with Hep C. This combination can be dangerous and cause more complications for each disease. Currently, liver disease related to Hep C is the leading cause of death among people with HCV-HIV co-infection.

Comparing Hep C and HIV
	Hep C	HIV
Transmission	Through contact with infected blood.	Through contact with infected blood, semen, vaginal fluids or breast milk.
How most people get it in Canada	Reusing drug-use equipment already used by someone else, particularly equipment for injection drug use.	Unprotected sex. Reusing drug-use equipment already used by someone else.
Testing	Antibody test looks for exposure. RNA test looks for infection. No anonymous or rapid testing available.	Positive antibody test shows infection. Both rapid and anonymous testing available at certain sites.
Treatment duration	Six months to a year depending on the Hep C genotype.	Lifelong HIV treatment.
Treatment regimen	Currently, peg-interferon with ribavirin.	Highly Active Antiretroviral Therapy (HAART) which is a combination of three or more anti-HIV drugs.
Response to treatment	HCV can be completely cleared from the body if treatment is successful. 20% of people will spontaneously clear the virus and not need treatment.	Levels of HIV can be reduced to undetectable levels but not cleared from the body.
How long virus survives outside the body	HCV can survive four days (possibly up to two weeks) outside the body.	HIV dies within minutes in open air outside the body.
Possibility of re-infection	There is no immunity to HCV. Re-infection can occur even if virus was cleared before (spontaneously or through treatment). People can be infected with more than one genotype.	Re-infection can occur sometimes with a resistant strain of HIV that does not respond to treatment.
Vaccine	No vaccine currently available for HCV.	No vaccine currently available for HIV.
Window period(for recommended testing)	Three to six months after exposure to virus.	Three to six months after exposure.
Part of body targeted	HCV replicates and multiplies in the liver leading to liver damage.	HIV targets immune cells (CD4+ cells) for replication causing weakening of the immune system.
Prevalence (estimates)	Canada: 250,000 infections Worldwide: 170 million	Canada: 58,000 infections Worldwide: 33 million

Co-infection Complications

Each disease makes the other more complicated. Research shows that people with both infections are likely to develop cirrhosis more quickly and may be at a greater risk for heart disease. Treatment decisions for both viruses are more challenging as people who are co-infected may respond differently to medications used to treat HIV or Hep C. (See Treatment for HIV and Hepatitis C for more information.) Therefore, all of the suggestions for reducing harm and maintaining health are even more important for people who have both infections. (See Harm Reduction for more information.)

Testing

Screening for Hep C is recommended for all people diagnosed with HIV, and vice versa. Keep in mind that having advanced, untreated HIV can sometimes lead to false negative results in Hep C antibody tests because the immune suppression caused by HIV reduces the body’s ability to manufacture antibodies. More tests may be required to get the full understanding of the status of HCV in the body.

Transmission: Similarities

Although separate and distinct viruses, HIV and HCV do share some similarities. Both viruses can be transmitted by blood-to-blood contact. Sharing materials contaminated with blood (including equipment for injection drug use, piercing, tattooing or medical procedures including blood transfusions) puts a person at risk for both viruses.

Transmission: Differences

HIV and HCV also have their differences. For example, bleach does not kill HCV but has been effective in reducing HIV transmission when used to clean drug-use equipment. Also, HIV is a fragile virus that does not survive long outside of the body, where HCV may survive for longer. Although both viruses are transmitted through blood-to-blood contact, HIV is transmitted more frequently through sex and childbirth than HCV.

Transmission: Interactions

Having HIV increases the chances of transmitting HCV through two routes: during childbirth and during unprotected sexual intercourse. A baby born to a mother co-infected with HIV and HCV is more likely to be infected with HCV than if the baby’s mother is infected only with HCV. The risk of sexual transmission of HCV is low but can greatly increase with the presence of sexually transmitted infections, HIV, menstruation or through certain sex practices, including rough sex, fisting, group sex or sex with multiple partners.

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