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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 |

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 |

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


Leveraging Health Systems Transformation to Cure Hepatitis C Among People Living with HIV - The Louisiana Curing Co-Infection project launched in May 2017 with the goal of increasing provider knowledge about screening, diagnosis, and treatment of HCV among co-infected individuals. The Department of Health partnered with three clinic sites in high-prevalence areas to increase HCV screening, retention, and cure among co-infected people of color through provider education and practice transformation.


Oklahoma’s AIDS Drug Assistance Program (ADAP) has been particularly successful in providing HIV/HCV co-infected clients with access to directly-acting antiviral (DAA) HCV treatment medications, primarily through their ADAP-funded insurance program.  Oklahoma has also leveraged existing relationships with two Ryan White Part C clinics to track and monitor the health outcomes (i.e., sustained virologic response (SVR)) among those clients that receive DAA HCV treatment.


Tennessee’s Statewide HIV/HCV Vulnerability Assessment was conducted as an ecological study using a dimension reduction statistical methodology across various local data sources (e.g., United States Census; surveillance data from multiple Tennessee Department of Health (TDH) programs, and the Tennessee Bureau of Investigation) to score each county’s risk for an HIV/HCV outbreak.  TDH used the ecological study to determine if more granular data improved insights into county-level HIV/HCV outbreak vulnerability as compared to the Centers for Disease Control & Prevention’s vulnerability assessment study.  This more detailed understanding will be used to inform public health practice and response. 

Check Your Understanding

Does your health department have an integrated HIV and hepatitis program? If not, what is working well versus what challenges exist pertaining to preventing HIV and HCV in populations of people who are at risk for both viruses?

Myriad strategies pertaining to joint prevention messages, co-testing, and guidelines for treating co-infected individuals exist. Peruse the health department examples on this page to gain insight into peer strategies.

How does your state’s rate of HCV cures compare to the rates of HCV prevalence? What barriers exist to offering more people access and support for HCV curative treatment?

Barriers may include, but are not limited to, sobriety restrictions, financial burdens, access to insurance, and lack of community and provider education.

How can you address “vulnerable counties” in your state to prevent HIV/HCV outbreaks before they occur?

If your state has vulnerable counties, please submit a CDC Determination of Need here. NASTAD’s Laura Pegram, Senior Manager for Drug User Health, can provide technical assistance. Please email her at