Living with HIV and Hepatitis C Co-infection


Starting 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

Things to consider when thinking about treatment

Starting treatment for HIV or hepatitis C is a big decision. This is because there are benefits and challenges to each treatment. Before starting either treatment, there are many issues, both medical and non-medical, to consider, including:

  • AdherenceYour ability to stick to (adhere to) the treatment regimen. Adherence is important for the drugs to work. This is true for both hepatitis C and HIV treatment. For hepatitis C, taking all of your medications increases the chance of being cured. For HIV, you need to have a certain amount of HIV drugs in your body to keep the virus suppressed. Missing doses leads to drug levels that drop too low to control the virus. It can also give the virus the chance to figure out how to make copies of itself even when exposed to the drug(s). If this happens the drug(s) will no longer work for you.

    Thinking about how taking medications every day may affect your life can help you stick to your treatment once you start taking it. Common issues that come up include managing side effects, taking pills in different situations of daily life and remembering to take pills on time.

    If you are at a point in your life where, for whatever reason, you are not able to take your medications regularly and as prescribed, take a clear and honest look at what’s giving you trouble. Solving these problems is a very individual matter. Your pharmacist, clinic nurse, social worker or friends who have been on treatment can often help you.

  • Managing side effects, both short term and long term, and if you feel strong enough and supported enough to cope with them. Hepatitis C treatments that include only DAAs have few side effects that tend to be mild or moderate. Learning as much as you can about the side effects of treatment and how to cope with them beforehand will help you make better decisions. (See “Dealing with side effects” for more in depth information.)
  • Other health problems, including heart disease, diabetes, kidney injury, anemia, obesity or mental health issues such as depression. These conditions may affect the specific drugs you take or how you can prepare for the side effects of treatment. For example, some people with depression start antidepressant medications a few weeks before starting hepatitis C treatment that includes peg-interferon.
  • How fast liver injury is happening. Your liver might not get worse or it could get worse very fast. Monitoring your liver health will give some information about how fast the disease is happening. Severe liver injury can make hepatitis C and HIV more difficult to treat and can also limit which HIV medications you can take.
  • Your support network. Joining a support group and talking with family and friends can play an important role throughout all phases of treatment.
  • If you are pregnant or your partner is pregnant, or if either of you wants to have a baby, see the section “You can have a healthy baby” for important information.

Your healthcare team can help you consider all of these factors so that you can come to a decision that is best for you. The most important thing is to start treatment when you are ready.     

Weighing optionsMaking sure your drugs work together

Sometimes when people take medications for more than one condition at the same time, these medications react with each other. This reaction is called a drug–drug interaction or more simply a drug interaction. Drug interactions can cause more side effects or change how effective a particular medication is.

It is important to be aware that some of the medications commonly used to treat HIV and hepatitis C can interact with one another. Other medications that you may be taking, including methadone, can also interact with certain HIV or hepatitis C medications.

Drug interactionsTalk to your doctor about the different medications you are taking so that he or she can help you avoid drug interactions. Getting your different prescriptions filled by a single pharmacy can also help avoid unexpected interactions.

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 HIV drugs are broken down by the liver and on rare occasions this can cause more injury to this organ. Your doctor may recommend switching to more liver-friendly HIV drugs or lowering the dose—the effects on the liver usually go away after these changes are made.

If you are taking HIV treatment, regular blood tests to monitor your liver health will help to identify possible problems. This is true whether or not you are also taking hepatitis C treatment. This way, most people can be on a treatment that is safe and effective.

Paying for treatment

The cost of treatment for HIV or hepatitis C is expensive. Some people have private drug plans that will cover the cost of treatment. If you do not, there are other options.

In Canada, there are different federal, provincial and territorial drug benefit programs to help cover these costs. Special authorization is sometimes needed in order for these medications to be covered by a public program.

In addition to government programs, many pharmaceutical companies that market HIV and hepatitis C drugs offer programs to help people cover costs involved with taking their medication.

CATIE offers more information about drug coverage programs for HIV and hepatitis C drugs.