Hepatitis C: An In-Depth Guide

 

Hepatitis C treatment for people with HIV and hepatitis C

The treatment options for people who are co-infected with HIV and hepatitis C have expanded. The cure rates for newer treatments tend to be as high for people who have HIV and hepatitis C as they are for people with only hepatitis C. The length of time on treatment may also be similar.  

Hepatitis C treatment regimens

The new highly effective direct-acting antiviral (DAA) medications that can cure most people are also effective in people co-infected with HIV. Many are taken for 12 weeks and have few side effects. They are taken orally.

Historically, peg-interferon and ribavirin were the only available hepatitis C medications for people co-infected with HIV. This combination is no longer used.

Many DAA medications are available in Canada for people co-infected with HIV. To learn more about different DAA combinations, see Hepatitis C drugs approved in Canada for adults. A person can speak to their healthcare provider to find out which combination would be most effective for them.

Paying for treatment is becoming easier as more programs are available to help pay for the medication, including publicly funded drug benefits programs, private health insurance and drug company programs. A healthcare provider can help a person figure out if they qualify for treatment and if they can get financial or other types of support from any of these programs. There is also more information about these programs in Treatment coverage in your region.

Starting hepatitis C treatment

Starting treatment is a decision to be made in consultation with a healthcare provider and takes into account many factors, including:

  • a person's overall state of health
  • the health of the liver 
  • how stabilized a person’s HIV is (HIV viral load, CD4 count)
  • the chances of successful treatment

In general, people co-infected with hepatitis C and HIV who are not on HIV or hepatitis C treatment will start HIV treatment (antiretroviral therapy or ART) before hepatitis C treatment to stabilize the immune system. Once a person’s HIV is under control, healthcare providers then consider treatment for hepatitis C. However, it is important to have the liver monitored regularly if a person has not started hepatitis C treatment because liver injury can progress more quickly for people who are co-infected with hepatitis C and HIV compared with people who only have hepatitis C.

Drug interactions

Sometimes when people take medications for more than one condition at the same time, these medications can affect each other. This reaction is called a drug-drug interaction, or more commonly, a drug interaction. Drug interactions can cause new side effects or more severe side effects or can change how effective a particular medication is. Regardless of the HIV medications used, ongoing monitoring of the liver through blood tests is important in order to identify possible liver complications. This way, most people can be on a treatment that is safe and effective.

Another type of drug interaction can occur when an existing medical condition such as hepatitis C changes how effective or safe a medication is. Many anti-HIV drugs, particularly a group called protease inhibitors, are broken down by the liver and may interfere with other medicines. For people with HIV and hepatitis C, a healthcare provider may recommend lowering the dose of a certain medication or switching to more liver-friendly drugs. Many people who have both hepatitis C and HIV tend to use a group of HIV drugs called integrase inhibitors as they tend to have fewer interactions with medicines used to treat hepatitis C.

A person taking HIV medications should check with their healthcare provider and/or pharmacist about possible drug interactions with hepatitis C medications.

For information on more topics related to treatment for HIV, see HIV Treatments.

Revised 2018.