Hepatitis C for people living with HIV:
testing, coinfection, treatment and support

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This guide is mainly about hepatitis C (HCV), and the difference for HIV-positive people compared to just having either virus on it's own. It is written with a positive outlook for management and treatment.

People with direct experience of HIV, hepatitis C or coinfection, have written much of this guide. Their personal accounts are included.

Full section index.
Introduction
First questions: What is hepatitis C (HCV)? How serious is HCV? Will HCV make my HIV worse? How many people have HIV and HCV? What should I do first after an HCV diagnosis? Who should I tell?
Newly diagnosed: Newly diagnosed with HCV. Newly diagnosed with HIV and HCV at the same time. Risk to others. Can I catch another type of HCV or HIV? Other types of hepatitis.
Hepatitis C transmission: How HCV is caught and passed on. Injecting drug use and HCV. HCV and other (non-injecting) drug use. HIV, HCV and sex. Heterosexual transmission of HCV. Sexual transmission of HCV in HIV-positive gay men. Mother to child transmission of HCV.
Natural history of hepatitis C: What does your liver do? How does HCV damage your liver? How can you protect your liver? Hepatitis C outside the liver. Acute and chronic infection. HIV and hepatitis C coinfection.
Issues affecting specific individuals: New HCV infections in HIV-positive gay men. Long-term coinfection from blood products or by injection drug use
Testing and monitoring: Tests to diagnose HCV. Routine blood monitoring. Hepatitis C viral load (RNA testing). HCV genotype. Liver enzyme tests: ALT and AST. Screening for cirrhosis and liver cancer. Liver biopsy and the alternatives.
Treatment and management: Who needs HCV treatment? How is HCV treated? Goals of treatment. When should HIV be treated first? When should HCV be treated first? HCV treatment and CD4 count. HIV treatment and HCV coinfection. HCV treatment and drug users. Retreating HCV. Managing cirrhosis. HIV/HCV and liver transplants.
Side effects and management strategies: HCV treatment side effects. Liver toxicity and HIV drugs. Therapetic drug monitoring (TDM). Depression, anxiety, and other psychiatric side effects Flu-like symptoms, weight loss and fatigue (feeling tired). Anaemia, neutropenia and thrombocytopenia Insomnia, rash, dry mouth, breathlessness, irritability and other side effects.
Deciding whether to treat hepatitis C: Advantages of treating HCV. Advantages of waiting. Treatment tips.
Research into new drugs: Information on new HCV drugs.
Vivir con la hepatitis C: Stress, alcohol, recreational drugs, smoking, diet, weight, herbal medicine. Support organisations.
Other viral hepatitis infections: About hepatitis A, B, D, E, F and G.
Controversial aspects of hepatitis C transmission, monitoring, care and treatment: Sexual transmission. Alcohol intake. Liver biopsy. HCV treatment for drinkers and injecting drug users. How long to treat genotypes 2 and 3. Retreatment: consensus interferon. Access to experimental HCV drugs.
HIV and hepatitis C: similarities and differences: Side-by-side comparison.
Glossary: Words and phrases explained.
Further information: Web links and resources
Lab results record sheet
Hepatitis C progression in HIV-positive people
How response to hepatitis C treatment is measured.
Hepatitis C treatment timeline for people with HIV
Diagram: the liver and related organs of the body
Personal accounts
Web-only content

Disclaimer
Information in this guide is not intended to replace information from your doctor or other healthcare workers. Decisions relating to your treatment should always be taken in consultation with your doctor.

Authors
This guide was written and compiled by Simon Collins (HIV i-Base) and Tracy Swan (Treatment Action Group, USA). Additional contributions and editorial comments are included from Sanjay Bhagani, Polly Clayden, Marc Ennals, Ramon Espacio, Loon Gangte, Charles Gore, Camilla Graham, Mauro Guarinieri, Marianna Iwulska, Robert James, Maxime Journiac, Svilen Konov, Luis Mendão, Silvia Petretti, David Pieper, Jack Summerside, Joan Tallada, Carmen Tarrades and Kate Thomson. Pictures by Beth Higgins and Simon Grindrod.

Additional thanks to the Hepatitis C Trust, UK for permission to use text from their website.

Information dates quickly. If you're reading after May 2008, please call in case an updated version is available. Not-for-profit copying is encouraged.

Funding for this guide was provided by The Monument Trust.

This is the web edition of the i-Base guide Hepatitis C for people living with HIV: testing, coinfection, treatment and support. This guide is available in UK clinics. You can order free printed copies or download a PDF version (657 Kb).