Hepatitis C: An In-Depth Guide

Co-infection with HIV

Increasingly, people in Canada who have hepatitis C are also living with the human immunodeficiency virus (HIV). This is partly because 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) puts a person at risk for both viruses. Having HIV can also make a person more susceptible to getting hepatitis C. (For more information, see How Hep C transmission happens)

Approximately, 71, 000 people in Canada are living with HIV, and an estimated 332, 000 people have a past or current Hep C infection. A substantial portion of people with HIV also have Hep C. The overlap is more common in certain groups, such as people who inject drugs.

People living with both HIV and hepatitis C may face challenges related to health and disease progression, treatment decisions and stigma. For example, liver disease related to hepatitis C is the leading cause of death among people who are co-infected. To face these challenges people need access to knowledgeable healthcare, information and support in order to manage their dual conditions and live long and healthy lives.

Comparing hepatitis C and HIV

Hepatitis C and HIV are separate and distinct viruses and there are many differences between them. However, they also share some similarities. Differences and similarities are outlined in the chart below:

Comparing Hep C and HIV

 

Hep C

HIV

Transmission

Through contact with infected blood.

Through contact with infected blood, semen, vaginal fluids, rectal fluids or breast milk.

How most people in Canada get it

Using drug-use equipment already used by someone else, particularly equipment for injection drug use.

 Unprotected sex (condomless sex or not using PrEP with a partner who has a detectable viral load)
Using drug-use equipment already used by someone else, particularly equipment for injection drug use.

Testing

Antibody test looks for exposure. RNA test looks for infection.
No anonymous or rapid testing is available in Canada at this time.

Positive antibody test shows infection.
Both rapid and anonymous testing are available at certain sites.

Treatment duration

 

8, 12 or 24 weeks

Lifelong HIV treatment.

Treatment regimen

 Multiple options, many based on direct-acting antiviral medications and many not including peg-interferon or ribavirin.

Antiretroviral Therapy (ART)—a combination of three or more anti-HIV drugs.

Response to treatment

Hep C treatment can cure Hep C.

About 25% of people will spontaneously clear the virus and without treatment.

Levels of HIV can be reduced to undetectable but not cleared from the body.

How long virus survives outside the body

HCV can survive for up to 6 weeks outside the body.

In certain conditions, such as inside a syringe, HCV can survive for up to 8 weeks.

HIV dies within minutes in open air outside the body.

In certain conditions, such as inside of a syringe, HIV can survive for up to 8 weeks.

Possibility of re-infection

There is no immunity to HCV. Re-infection can occur even if the virus was cleared before.

This is not applicable to HIV because HIV cannot be cleared from the body.

Possibility of infection with more than one strain

People can be infected with more than one genotype, but this is rare.

People can be infected with more than one strain of HIV.

Vaccine

No vaccine currently available for HCV.

No vaccine currently available for HIV.

Window period (for recommended testing)

2 to 3 months after exposure to HCV.

3 months after exposure to HIV.

Part of body targeted

HCV mostly replicates and multiplies in the liver, leading to liver damage.

HIV mainly targets immune cells (CD4+ cells) for replication, causing weakening of the immune system.

Revised 2015.