In the UK, standards for HIV treatment and care are set and monitored by the British HIV Association (BHIVA), the professional association for HIV doctors and other healthcare professionals. The most recent guidelines on HIV and hepatitis co-infection were produced in 2017 (see www.bhiva.org/hepatitis-guidelines.aspx). Experts now agree that treatment recommendations for people with HIV and hepatitis C should be the same as for everyone else with hepatitis C, so your treatment will follow national guidelines for hepatitis C treatment.

Like everyone else living with HIV, people with HIV and hepatitis C co-infection are advised to start antiretroviral treatment soon after being diagnosed with HIV. People with co-infection may particularly benefit from early treatment because having well-controlled HIV and restored immune function reduces the risk of liver disease progression.

Current guidelines recommend that everyone with HIV and HCV co-infection should start hepatitis C treatment with direct-acting antivirals (DAAs). Treatment is especially urgent if you have moderate or worse liver fibrosis (stage F2 to F4). But everyone with HIV and HCV co-infection can benefit from early hepatitis C treatment because their liver disease may progress faster than it would in an HIV-negative person. Where there is a waiting list for treatment, people with HIV and HCV co-infection are likely to be prioritised, especially if you have moderate or severe fibrosis.

People on antiretroviral treatment for HIV can be successfully treated for hepatitis C at the same time. Given the number and variety of HIV and hepatitis C medications now available, most people with co-infection can put together well-tolerated regimens for treating both viruses.

HIV treatment should not be interrupted in order to start hepatitis C treatment. However, you might need to change some of your HIV medications or use different doses of HIV or HCV drugs to make sure that treatment remains effective and does not cause worse side-effects.

The following drugs or antiretroviral combinations have no problematic interactions with DAAs used in hepatitis C treatment:

• abacavir/lamivudine (Kivexa)
• tenofovir disoproxil (TDF)/emtricitabine (Truvada)
• tenofovir alafenamide (TAF)/emtricitabine (Descovy)
• rilpivirine (Edurant, also combined with TDF/emtricitabine as Eviplera and TAF/emtricitabine as Odefsey)
• dolutegravir (Tivicay, also combined with abacavir/lamivudine in Triumeq)
• raltegravir (Isentress).

If you haven’t started HIV treatment yet and have a low CD4 cell count (below 350), it is recommended to start HIV treatment first to improve your immune function. Once HIV treatment is started, it is important not to stop it, as studies have shown this can contribute to liver problems.

Some antiretroviral drugs can cause liver side-effects, and these may occur more often in people with liver disease due to hepatitis C. However, most widely used modern HIV drugs seldom cause serious liver toxicity. In addition, people with seriously impaired liver function may not be able to process HIV medications properly. Some drugs may require dose adjustments, while others should not be used by people with advanced liver disease.

The health of your liver should be regularly monitored during HIV and hepatitis C treatment. Find out more about liver monitoring tests in NAM’s booklet CD4, viral load & other tests.