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Hepatitis C treatment for people with co-infection

Current guidelines recommend that you start hepatitis C treatment if you have HIV and HCV co-infection with moderate or worse liver fibrosis (stage F2 to F4) and you have good prospects for successful therapy. People with advanced liver cirrhosis should be treated in specialised centres.

However, the guidelines also suggest that everyone with co-infection should consider hepatitis C treatment sooner if the risks outweigh the benefits. This is because your liver disease may progress faster than it would in an HIV-negative person. This is especially the case for people who have a high likelihood of a cure.

It used to be recommended that you have a liver biopsy before starting hepatitis C treatment, but this is no longer the case. However, if you have had a biopsy or FibroScan, and the results show little or no fibrosis, you can probably wait until interferon-free treatment is available. Your doctor will discuss your options with you. If you choose to defer treatment, you should have your liver health monitored at least yearly and start treatment if you start to show rapid disease progression.

If you are not yet on HIV treatment or you have a high CD4 cell count, you can start hepatitis C treatment right away. But if you haven’t started HIV treatment and you have a low CD4 cell count (below 350), it is recommended you start HIV treatment first to increase your CD4 cell count. Having both an undetectable HIV viral load and a high CD4 cell count help hepatitis C treatment work better.

The British HIV Association recommended in 2014 that people with HIV and HCV co-infection should be treated with sofosbuvir plus another drug depending on HCV genotype. People with genotype 2 should be treated with sofosbuvir and weight-based ribavirin for 12 weeks. People with genotype 3 should be treated either with sofosbuvir, pegylated interferon and ribavirin for 12 weeks, or sofosbuvir and ribavirin for 24 weeks.

The current recommendation for people with co-infection who have HCV genotype 1 and have not previously taken HCV treatment is sofosbuvir with daclatasvir or simeprevir for 12 weeks, with ribavirin for 24 weeks. These regimens also appear effective for re-treatment, although 24 weeks of treatment is generally recommended. Sofosbuvir with pegylated interferon and ribavirin for 12 weeks is only recommended for people who have not taken HCV treatment previously. You may need to discuss changing some of your HIV medications before starting a course of hepatitis treatment. You can find out more about interactions with anti-HIV drugs in NAM’s booklet Anti-HIV drugs.

If you have HCV genotype 4, it is recommended you take sofosbuvir with pegylated interferon and ribavirin for 12 weeks. While genotype 4 is considered hard to treat (like genotype 1), sofosbuvir is active against genotype 4.

The guidelines do not recommend treatment with two older direct-acting antivirals, telaprevir and boceprevir. These drugs are less effective and have frequent side-effects.

These guidelines do not include the newest direct-acting antiviral combinations, sofosbuvir/ledipasvir (Harvoni), and ombitasvir, paritaprevir and ritonavir (Viekirax) for use in combination with dasabuvir (Exviera). The guidelines for treatment of co-infection will be updated as new direct-acting antivirals become available and NHS funding is approved for use of these new drugs.

HIV & hepatitis

Published April 2015

Last reviewed April 2015

Next review April 2018

Contact NAM to find out more about the scientific research and information used to produce this booklet.

Hepatitis information

For more information on hepatitis visit infohep.org.

Infohep is a project we're working on in partnership with the European Liver Patients Association (ELPA).

Visit infohep.org >
This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.