Infection with more than one virus is commonly known as co-infection. It is possible for people to be co-infected with two or three of the hepatitis viruses, or with HIV and one or more of the hepatitis viruses. Hepatitis C and B co-infection, and hepatitis C and HIV co-infection are described below.
Hepatitis C and B Co-infection
It is possible to contract both viruses at the same time or a person with one virus may be infected with the other at a later time as both viruses are transmitted through blood-to-blood contact. Co-infection with both hepatitis C and hepatitis B may lead to more severe liver disease, including cirrhosis and/or liver failure, and increases the risk of developing liver cancer.
Co-infection with hepatitis C and B can be difficult to diagnose due to the interaction of the viruses which usually leads to one virus becoming dominant over the other. Suppression of one hepatitis virus does not mean that it has been eliminated from the body. It simply means that its effects have been slowed or stopped.
Treatment of hepatitis B and hepatitis C co-infection follows the same treatment criteria applied to people with hepatitis B or hepatitis C only. The treatment approach is determined by clinicians based on which virus is dominant. Treating co-infection must be approached cautiously.
Hepatitis C and HIV Co-infection
Hepatitis C, hepatitis B and HIV share major routes of transmission and risk factors. People who inject drugs are at elevated risk for hepatitis C and HIV co-infection. Sexual transmission is responsible for the majority of the cases of HIV-hepatitis B co-infections. Additionally, sexually acquired hepatitis C is observed mainly amongst HIV positive men who have sex with men.
Because HIV decreases the effectiveness of immune responses it can worsen hepatitis C-related liver disease, leading to more rapid progression to cirrhosis and to earlier development of liver cancer. It is unclear what impact, if any, hepatitis C has on the progression of HIV.
Effective treatment is available for both hepatitis C and HIV, and vaccination against hepatitis A and B is essential. Co-infection with hepatitis C and HIV requires regular blood tests and viral load tests to track disease progression and it is strongly recommended that anyone with co-infection find a doctor experienced in both hepatitis C and HIV. An AIDS Council or community Hepatitis Organisation can help.