Hepatitis C: Co-infections

HIV and hepatitis C co-infection

Hepatitis C now poses one of the most serious clinical challenges to people living with HIV. Almost a third of all people living with HIV in Europe also have hepatitis C virus (HCV) infection.1

Co-infection with HIV speeds up the rate at which hepatitis C causes liver damage. Cirrhosis and liver cancer occur much more quickly in people with HIV and HCV co-infection.

Antiretroviral treatment for HIV has reduced the number of deaths caused by HIV, and liver disease caused by hepatitis C is now one of the most frequent causes of death among people living with HIV in Europe.



Scarring of the liver – the structure of the liver is altered. See also ‘fibrosis’, which is moderate scarring. See also ‘compensated cirrhosis’ and ‘decompensated cirrhosis’.


The number of events that we would expect to occur during a specified period of follow-up (e.g. 100 person-years). Particularly useful when follow-up periods vary from person to person in a study, or where a person may experience more than one event.


The stage of hepatitis infection refers to the amount of liver scarring (fibrosis) detected by biopsy. Usually measured on scales of 0 to 4, or 0 to 6 (higher numbers indicated more severe inflammation). 

European guidelines recommend that all people living with HIV should be tested for hepatitis C infection.

Mothers with HIV and HCV co-infection are significantly more likely to transmit hepatitis C to their babies while giving birth.

Hepatitis C infection does not speed up HIV disease progression but untreated HIV infection does speed up the rate of liver damage caused by hepatitis C. For this reason European guidelines recommend that all people living with HIV should receive treatment for hepatitis C regardless of the stage of liver disease. Treatment of people with co-infection should be carried out by doctors experienced in the treatment of both infections.

This information was originally adapted from Hepatitis C: Understanding a silent killer, published by the European Liver Patients Association. It was updated in 2016.


  1. Thomas DL Hepatitis C and human immunodeficiency virus infection. Hepatology 36 (5 Suppl 1): S201-S209 (I b), 2002
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