Living with HIV and Hepatitis C Co-infection


Once you’ve started treatment for HIV or hepatitis C

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

How to know whether treatment is working

HIV treatment slows down the production of HIV in your body. This leads to drops in your HIV viral load.

The goal is to have your HIV viral load become undetectable.

Viral load

HIV viral load usually becomes undetectable within three to four months, depending on which treatments you take and how high it was before treatment. Don’t be alarmed if your viral load doesn’t become undetectable right away. Talk to your doctor about how long it could take in your case.

Once your HIV viral load becomes undetectable, it should stay there. If your HIV viral load becomes detectable again, this may be a sign of a problem with your HIV treatment.

CD4 counts don’t usually increase as quickly as HIV viral load drops, especially if you’re co-infected with hepatitis C. Once HIV is under control, your immune system should become stronger.

During hepatitis C treatment your hepatitis C viral load may or may not be measured to assess treatment response. It will be measured after treatment. The most important measure of treatment is the hepatitis C viral load test three or six months after the end of treatment. If the viral load is undetectable at this time, it means you have been cured. This is also called a sustained virological response (SVR).

Undetectable and cured: two important words

An undetectable HIV viral load means that the amount of HIV is so low that the test used to measure HIV viral load can no longer detect the virus in the blood. An undetectable HIV viral load allows your immune system to rebuild itself so that you can remain healthy. It does NOT mean that HIV is gone from your body. You are still HIV positive. Currently, there is no cure for HIV.

With hepatitis C treatment, hepatitis C viral load can also become undetectable. If hepatitis C viral load remains undetectable three or six months after you have finished treatment, a person is cured from hepatitis C.

Being cured from hepatitis C may stop further injury to the liver and reduce the risk for liver failure and liver cancer. In many people, the liver is able to heal itself over time once hepatitis C has been cured.

Dealing with side effects

In general, people who are co-infected and taking treatment for HIV, hepatitis C or both experience the same side effects as people who are living with one virus and taking one treatment. The main difference is that some side effects may happen more often or feel more intense among people who are co-infected.

The good news about HIV drugs is that newer drugs are much easier for the body to tolerate than older drugs. Also, the side effects of HIV treatments often become less intense with time.

Work with your healthcare team to plan for side effects before starting treatment.

Planning for side effects means understanding what side effects you might experience and thinking of ways to manage them. For example, there are medications your doctor can prescribe to help manage diarrhea during the first few weeks after starting HIV treatment. Or you can manage nausea caused by some hepatitis C treatments by eating many small meals throughout the day, sipping water and taking medications to reduce nausea.

If you are using substances, you may want to talk to your doctor or nurse about how to get help for dependence on alcohol or street drugs. These changes may make it easier to take treatment.

Some people are tempted to stop their treatment early because of side effects. But, for the treatment to work, it is important to take all doses exactly as prescribed. If you experience severe side effects, you should talk to your doctor or nurse about ways to reduce them.

CATIE also offers information on HIV and hepatitis C drug side effects (and practical tips for managing them) online at Or you can call 1-800-263-1638 to speak with someone knowledgeable about HIV and hepatitis C treatments.

Natural health products

Natural health products are vitamins and minerals, herbal remedies, homeopathic medicines, ancient systems of healing, probiotics and supplements.

Talk to your doctor and pharmacist about any natural health products you take or are thinking of taking.

People take natural health products for various reasons, including preventing or managing drug side effects. For example, antioxidant supplements (such as vitamins C and E, N-acetyl-cysteine (NAC) and co-enzyme Q10) are popular among some people with HIV because they may help protect the body’s cells from injury caused by HIV. However, no natural health product has proven to be effective as a treatment for HIV itself or as a treatment for hepatitis C.

While natural health products do not require a doctor’s prescription, they have benefits and side effects, just like other drugs. Some natural health products can also interact badly with medications used to treat HIV, hepatitis C and other infections and conditions. This is especially true for herbs. For example, St. John’s wort, an herb used to treat depression, can cause problems with medications used to treat HIV and hepatitis C. Milk thistle, an herb that some people believe may improve liver health, can also cause problems with many medications, including those used to treat HIV and hepatitis C.

Consider visiting a doctor who specializes in naturopathic medicine. The Canadian Association of Naturopathic Doctors (CAND) has information on regulated naturopathic doctors across Canada. Call the CAND at 1-800-551-4381 or go to

For more information on herbal therapies and complementary therapies for people living with HIV, check out CATIE’s practical guides online.

After hepatitis C treatment

After treatment

If treatment cured the virus: Depending on the health of your liver, your doctor may want to continue monitoring for liver cancer. He or she may recommend a screening test every six to 12 months, for example. You may also continue to experience some symptoms of liver injury, such as tiredness or difficulty concentrating. For many people, the liver heals itself over time.

The body does not develop protection against the hepatitis C virus and it is possible to become infected again. Understanding how hepatitis C can pass from person to person will help you take steps to protect yourself in the future. (See “Protecting yourself, protecting others”.)


If treatment did not cure the virus: With DAA treatments having high cure rates, it is less likely that people will not be cured. However, if hepatitis C treatment does not cure the virus, people may experience many different emotions. You may want to talk about your feelings with someone such as a friend, family member, counsellor, support worker, nurse or someone at a local HIV or hepatitis organization.

Focus on doing what you can to reduce liver damage and to live and feel well. (See “Things you can do to take care of your health”.) Continue to follow up with your doctor to monitor your liver.

There may be other options for you, such as:

  • Trying treatment again, especially when new hepatitis C drugs become available.
  • Having a liver transplant. Liver transplantation is an option when someone has liver failure. Many people feel better, spend less time in hospital and are able to lead a more active life after receiving a liver transplant. But transplantation is not a cure for hepatitis C. If the hepatitis C virus is still in the body, it will infect the new liver. In the past, HIV-positive people in Canada were excluded from receiving a transplanted organ. However, in some provinces, HIV-positive people are now considered for organ transplants.