Living with HIV and Hepatitis C Co-infection


Things you can do to take care of your health

Some of this information is no longer accurate. We are in the process of updating this content. For more current information, please see the Hepatitis C: An In-Depth Guide’s treatment section

Get connected

HIV and hepatitis C services in your area can offer support and information. They can also help connect you to other people living with HIV, hepatitis C or co-infection. For information on services in your area, check out, or contact CATIE at 1‑800-263-1638.

Facing emotional problems on your own can be very difficult. Help is available. If you are feeling down or depressed, it’s important to talk about it with a doctor or a counsellor. There are different kinds of counselling and therapy available. Some of these are one-on-one (where it is just you and a counsellor) and some are done in groups (where you, other people and a counsellor all meet together). The setting and type of service you receive will depend on what kind of support you’re looking for and which services are available in your community.

Build a healthcare teamHealthcare Team

Building a healthcare team that you trust can help you live better with HIV and hepatitis C. In addition to a doctor and nurse, you may also see specialists—doctors who concentrate on a particular condition—such as an infectious disease specialist, HIV specialist or liver specialist (a hepatologist). Other people who can support you include a pharmacist, naturopath, counsellor, psychologist, psychiatrist, dietitian or social worker.

Some services provide support and care for both HIV and hepatitis C in one place and at the same time. In other cases, people get care for their HIV, hepatitis C and other health issues in different places.

Some people who are co-infected use street drugs. Some healthcare professionals have negative attitudes towards people who use drugs. This can make it hard to trust them.

If you aren’t sure where to start when putting together your team, your local HIV or hepatitis C organization or community health centre may be able to help. Remember, every person has the right to good, respectful medical care.

No matter what your team looks like, it’s a good idea to keep all of your health information together. This will help you and your team share information. A personal health record makes it easier to keep track of your prescriptions and appointments, to collect and review your test results and look for trends over time. CATIE has a personal health record available for downloading and printing.

Get the right tests

Differences between viral loads

HIV and hepatitis C virus naturally make copies of themselves (replicate) at different speeds—don’t be alarmed by hepatitis C viral loads that are a lot higher than your HIV viral loads.

The right testsYour doctor will likely recommend a variety of tests to check (monitor) how HIV and hepatitis C are affecting you, your immune system and your liver. You and your doctor will decide how often you have each of the tests.

An HIV viral load test measures the amount of HIV in your blood. The viral load test measures the number of copies of HIV in a millilitre of blood. Generally, the higher the viral load, the faster HIV will attack the immune system.

A hepatitis C viral load test measures the amount of hepatitis C virus in your blood. This test is sometimes called an RNA test or a PCR test. Unlike HIV and the immune system, a higher or lower hepatitis C viral load does not imply more or less liver damage.

Viral load testing is mostly used before starting treatment and during treatment to monitor how treatment is working. It is especially important not to focus on any one number, but to look at trends over time.

Your CD4 cell count will give you and your doctor a rough idea of how strong your immune system is. Generally, you should be getting your CD4 count checked every three to six months. It may make sense to check it more often if you’ve been stressed or sick.

Liver tests are used to look at the health of the liver. Many doctors recommend liver tests every three to six months when you’re co-infected with HIV and hepatitis C. These tests include:

  • Blood tests (some check the levels of liver enzymes, such as ALT and AST, and some measure liver function, such as bilirubin, prothrombin time and albumin)
  • Ultrasound (which takes a picture, like a photograph, of the liver to measure how much damage there is)
  • Fibroscan (which measures how scarred the liver is; it is also called transient elastography; Fibroscan machines are available in some clinics in Canada)
  • Liver biopsy (which uses a small needle to take out a tiny sample of the liver that the doctor can look at under the microscope to check for damage)

More and more, doctors are using combinations of less invasive tests, such as Fibroscans and blood tests, instead of biopsies, which are minor surgery and cause discomfort in some people.

In severe cases, cirrhosis from hepatitis C can lead to liver cancer. Finding cancer in its early stages can lead to more successful treatment. Talk with your doctor about your risk for liver cancer and a screening schedule for you.

Take simple steps to look after your health

There are lots of things you can do to take care of your health, keep your immune system strong and look after your liver.Healthy choices

Living healthy can be hard if you don’t have a safe place to live, much money or clean water. Do the best you can. Every bit helps.

  • Try to quit or cut down on alcohol. The process of breaking down alcohol in the body puts an extra strain on the liver and can cause more injury.
  • Try to quit or cut down on smoking. Smoking tobacco can lead to other health issues such as heart disease, cancer and breathing problems. Speak to your doctor, nurse or pharmacist about help for quitting.
  • Try to quit or cut down on street drugs. Some drugs may affect your liver or your ability to take certain HIV or hepatitis C medications. It may become harder for your liver to break down the drugs and there’s a higher risk for overdose. For information on safer drug use, consider talking to a harm reduction worker or a doctor you trust.
  • Consult with your doctor or pharmacist before taking painkillers and other medications, vitamins, herbs and supplements. Some are more liver friendly than others. If you are on treatment for HIV and/or hepatitis C, speak with your doctor about possible interactions.
  • Exercise, rest and relaxation are all important. Find the right balance for you. A health professional can give you advice for your situation.
  • Eat a healthy and balanced diet. Choose fresh foods over salty, sugary, fatty and fried foods whenever possible. Drink plenty of water.
  • Get tested for hepatitis A and B. Both of these viruses also infect the liver and can make liver damage worse if you already have hepatitis C. There are vaccines to protect against hepatitis A and B. If you have never been vaccinated, it’s something to consider, especially if you inject drugs, travel or have multiple sexual partners.
  • Get regular checkups to monitor your overall health. When thinking about health, it’s important not to focus only on liver health and CD4 cell counts—there are other health issues that are linked to HIV, hepatitis C and co-infection. Let your doctor know about any problems you are having, changes you notice or if something feels different. These changes may or may not be related to HIV or hepatitis C.
  • Try to take care of your emotional health. Some people with hepatitis C and HIV experience mental health issues, such as stress, depression or anxiety. Different people find different things can help. You might talk to someone you trust, do something nice for yourself, get some exercise or make a healthy meal. If you find that you feel down a lot of the time and can’t enjoy things you usually enjoy, or are feeling very stressed or anxious, talk to a counsellor or your doctor or nurse. Some people find it helpful to talk to others who are living with HIV, hepatitis C or both.

Alcohol: Thinking about cutting back?

Drinking less alcohol is one of the best things you can do for your health when you are co-infected with HIV and hepatitis C. If you want to try to drink less, try different strategies to discover what works for you. You might: 

  • Set a drinking goal and try to stick to it.
  • Space out alcoholic drinks with non-alcoholic drinks such as water.
  • Switch to smaller drinks or drinks with lower alcohol content (three percent instead of five percent, for example).
  • Seek support through a support group, addiction treatment or counselling.

CATIE offers more information on how to live better with HIV and hepatitis C—including nutrition information, sharing information about your diagnosis and more—online at

Learn about the treatments for HIV and hepatitis C

Treatments are available for HIV and for hepatitis C. You and your healthcare team will decide on how to best treat the two viruses. The treatments are different in several ways. (See “Different viruses, different treatments” for more information.)