
Chapter 7: HIV/HCV Co-Infection

Hepatitis C virus (HCV) prevalence among PWID is as high as 80%, and of the 1.2 million people living with HIV nationally, about 25% are co-infected with HCV. HCV affects the liver, and co-infection with HIV further complicates the effect on the body. According to the CDC, HIV/HCV co-infection more than triples the risk for liver disease, liver failure, and liver-related death from HCV alone.
Like HIV, HCV is highly stigmatized. Stigma may prevent people from getting tested and treated, particularly if they inject drugs. HCV can be cured, but one of the main barriers for PWID accessing this cure is stigma. Many providers do not seek cures for PWID with HCV due to perceptions that PWID will not adhere to the treatment regimen, that their behaviors will cause re-infection, and/or that these efforts are not a justifiable use of funds. Studies show that these stigmatized sobriety restrictions are ill-informed, and PWID are just as likely to adhere to treatment regimens as those who do not inject drugs. The presence of HIV exacerbates the effect of HCV on the body and vice versa. Combining ART and HCV cures is an integral practice in reducing transmission rates of both viruses, particularly in an era of such increased rates of opioid use.
The importance and opportunity of successful treatment of HCV for PLWH | HIV.gov
HCV treatment has significantly improved – in terms of efficacy and reduction of side effects. Many people do not understand the strides that have been made in curing HCV, and the importance of successful treatment of HCV for PLWH. 17 min, 34 sec
Lessons from an Outbreak of HIV and HCV Infections in Southern Indiana | AIDS.gov
Many people are aware of the HIV/HCV outbreak in Scott County, Indiana. In a town of less than 5,000 people, about 200 people were diagnosed with HIV due to injection drug use, 92% of whom eventually became co-infected with HCV as well. Provider and community education, access to healthcare, preventive services, and harm reduction philosophies and practices could have prevented the outbreak in Scott County, Indiana. Since then, the CDC tracks vulnerable counties and jurisdictions experiencing or at-risk of outbreaks HIV/HCV co-infection to prevent an outbreak before it occurs. 2 min, 6 sec
Health Department Examples
Key Resources
HIV and Viral Hepatitis Fact Sheet | CDC 2 pages
Additional Resources
Medicaid 1115 Waivers Exemptions for People Living with HIV and Hepatitis | NASTAD 6 pages
Medicaid 1115 Waivers Exemptions for HIV and Hepatitis Programs | NASTAD 6 pages