Pre-fix: A guide for people with Hep C or HIV who inject drugs

Treatment for Hep C or HIV

Tracking your health

If you’re seeing a doctor regularly, they will be tracking your health. This will help you make decisions about treatment for Hep C (hepatitis C) or HIV. Your doctor may also monitor other health issues such as your mental wellness, other infections and your heart and lungs.

The main tests for Hep C are liver function tests, to see how healthy your liver is, and tests to see whether the Hep C virus is causing other health issues, such as diabetes or kidney or thyroid problems.

The main tests for HIV  are the CD4 count, which measures the strength of your immune system, and the HIV viral load test, which measures how much HIV is in your blood.

What is Hep C treatment?

There is a cure for Hep C (although there is no vaccine). People often talk about clearing the virus; this is the same as a cure.

People who use injection drugs have been successfully treated for Hep C. Treatment guidelines for Hep C—the official recommendations that doctors use to guide their decisions about treatment—say that using streets drugs is not a reason to withhold Hep C treatment. However, it’s important to be as stable as possible, because you need to be able to follow the medication schedule to give yourself the best chance of clearing the virus. Not everyone with Hep C decides to take treatment. For some people, liver damage happens so slowly that they decide not to take treatment right away. Talk to your doctor about what treatment options are best for you.

“For so long, as drug users we’ve been told that doctors can’t help us. We need to let people know that that is actually not the case. There are treatment options. Just because you are using does not mean you are not eligible for treatment.” Jennifer

Treatment for Hep C means taking a combination of medications. Most combinations include medications called direct-acting antivirals (DAAs). These are taken orally (by mouth). DAAs are a group of medications that directly block the ability of the hepatitis C virus to make copies of itself.  DAA treatments have high cure rates and relatively few side effects. Some DAA combinations are taken for up to 12 weeks.

Other Hep C treatment combinations include the drug peg-interferon, which is given by an injection once a week and can cause more serious side effects. These combinations are generally less effective than combinations with only DAAs, but they remain an important option for some people with Hep C.

Depending on what strain of Hep C you have (there are six strains), treatment can last between eight weeks and six months.

CATIE has lots of up-to-date Hep C treatment information. Check out Choosing a drug combination for chronic hepatitis C and Chronic hepatitis C treatment combinations.

What is HIV treatment?

HIV can be controlled but not cured. People who use injection drugs can take HIV treatment. The treatment guidelines for HIV—the official recommendations that doctors use to guide their decisions about treatment—say that using street drugs is not a reason to withhold HIV treatment. Talk to your doctor about what treatment options are best for you.

HIV treatment consists of a combination of drugs that is taken every day. These medications will decrease the amount of the HIV virus in your body (called HIV viral load) and will allow your body to build its defenses against other infections.

HIV is a lifelong disease, and almost everyone with HIV takes treatment. We now know that people with HIV should start taking HIV treatment as soon as possible after diagnosis. Effective treatment also lowers the chance of passing on HIV through sex. You and your doctor will choose the best combination of drugs for you. While there are many to choose from, most people who start HIV treatment can take just one or two pills a day. Be as honest as you can about your street drug use with your doctor. Your doctor can also help you find a treatment that best fits your schedule and lifestyle. Some HIV medications may be more suitable with other prescriptions or street drugs you use.

CATIE provides a lot of information about HIV treatment.

It’s important not to share your medications with anyone else who is also on HIV treatment. Even if the pills look similar they don’t all work in the same way. If you switch medications on your own, they may stop working.

What if you have both Hep C and HIV?

Hep C and HIV are different viruses with different tests and treatments. If you are living with both viruses, both can be treated. You and your doctor will decide when is the best time for you to start treatment and whether to take Hep C or HIV treatment first. Starting treatment for both viruses at the same time is not recommended. CATIE’s booklet Living with HIV and Hepatitis C Co-infection contains more info.

Treatment and prison

What if you’re in prison and want to start treatment?

If you were on Hep C or HIV treatment before you went into prison, you have the right to continue treatment while in prison. If you would like to start treatment while you are in prison, you will need to get a prison doctor or specialist to prescribe Hep C or HIV medications for you, which will then be given to you by prison healthcare. Starting treatment may not be an option in provincial prisons. Some federal prisons have prisoners who are trained and available to talk to you about health issues (called peer health workers or peer education and counselling (PEC) workers). 

If you have been receiving treatment in prison and are going to be released, try to get connected with a doctor or community health organization in the area where you are planning on living, so you can continue treatment. This can be hard if you don’t know what community you will be released to. Prison healthcare staff should assist you with this, but you can also call PASAN (1-866-224-9978) for help finding support in or close to the community where you will live. Some prisons have prison outreach workers from local community health organizations who may also be able to assist with release planning.