Co-infections and co-morbidities with hepatitis C
- Some people have hepatitis C infection in addition to other health conditions. Health conditions that are more commonly seen with hepatitis C include HIV, hepatitis B and chronic kidney disease.
- For people with HIV and hepatitis C co-infection, HIV treatment is usually started first.
- For people with hepatitis B and C co-infection, treatment for hepatitis B is often started first.
- There are safe and effective hepatitis C treatments for people with chronic kidney disease.
- People with HIV and hepatitis C co-infection, hepatitis B and C co-infection, or chronic kidney disease and hepatitis C have hepatitis C cure rates as high as people without any co-infections or co-morbidities.
People in Canada who have hepatitis C may also be living with other health conditions. Health conditions that are more commonly seen with hepatitis C include HIV, hepatitis B and chronic kidney disease. These three health conditions should be considered when discussing and starting hepatitis C treatment.
Hepatitis C treatments are highly effective and cure more than 95% of people who complete treatment. In the past, there were challenges treating and curing people who had hepatitis C along with some other health issues. However, now that highly effective direct-acting antiviral (DAA) treatment is available, people with hepatitis C and HIV, hepatitis B and/or chronic kidney disease have cure rates as high as people without any co-infections or co-morbidities.
Sometimes when people take prescription drugs, over-the-counter drugs, herbs or supplements 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, they can increase the severity of existing side effects or they can change how effective a particular medication is.
A healthcare provider should know about all the medications (prescribed or not prescribed), herbs and supplements a person is taking so they can choose a hepatitis C treatment that does not have drug interactions or so they can develop a plan to manage drug interactions.
HIV and hepatitis C co-infection
An HIV and hepatitis C co-infection means that a person has both HIV and hepatitis C infections. HIV is a virus that weakens the immune system, which is the body’s built-in defence against diseases.
With HIV and hepatitis C co-infection, liver injury can happen more quickly. There is no cure for HIV, but treatment can keep the infection under control.
Everyone with hepatitis C should be tested for HIV before starting treatment. For people with HIV and hepatitis C co-infection, HIV treatment is usually started first. In some cases, there could be drug interactions between HIV and hepatitis C treatments, which would require a change in HIV treatment.
Hepatitis B and C co-infection
A hepatitis B and C co-infection means that a person has both hepatitis B and hepatitis C infections. Similar to hepatitis C, hepatitis B is a virus that infects the liver and causes injury.
People can have an acute hepatitis B infection that clears on its own without treatment, or they can develop chronic hepatitis B infection (hepatitis B infection that lasts for more than six months). There is no cure for chronic hepatitis B, but treatment can keep the infection under control.
Everyone with hepatitis C should be tested for hepatitis B before starting treatment. If a person has chronic hepatitis B, they will generally start hepatitis B treatment first. This is because with hepatitis C treatment, in rare cases there can be a flare-up of the hepatitis B virus, which can lead to serious liver injury and complications.
There is a vaccine for hepatitis B. People with hepatitis C who have never had hepatitis B or have never been vaccinated against hepatitis B should be offered a hepatitis B vaccination.
Chronic kidney disease and hepatitis C
A person with hepatitis C can also have chronic kidney disease. Chronic kidney disease occurs when there is lasting damage to the kidneys over a long period of time. In rare cases, hepatitis C can worsen kidney injury in people with chronic kidney disease.
The kidneys process some hepatitis C treatments. With chronic kidney disease, the kidneys slowly lose this ability, which can make some hepatitis C treatments less safe to take. However, there are hepatitis C treatments that are safe for people with chronic kidney disease. A healthcare provider will recommend a treatment that is approved for a person with advanced kidney disease.
Resources for service providers
- Hepatitis C Basics – eduCATIE online course
- Hepatitis C Treatment – eduCATIE online course
- Hepatitis C treatment in the new DAA era: frontline implications – CATIE webinar
- Hep Drug Interactions – University of Liverpool online drug interaction checker
Resources for clients
- 6 things to know about Hep C – CATIE brochure
- Curing hepatitis C: What you need to know – CATIE booklet