References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Hepatitis C and HIV co-infection affects approximately 5-10% of people living with HIV in the UK. Having both viruses complicates treatment and accelerates liver damage if hepatitis C is left untreated. The good news: hepatitis C is now curable in over 95% of cases with direct-acting antiviral (DAA) therapy, even in people with HIV.
How Are Hepatitis C and HIV Connected?
- Shared transmission routes: Both can be transmitted through blood (needle sharing, needlestick injuries). Hepatitis C is increasingly transmitted through sexual contact, particularly among men who have sex with men
- HIV accelerates liver damage: Co-infected people progress to cirrhosis faster than those with hepatitis C alone
- Immune suppression: HIV weakens the immune system’s ability to control hepatitis C naturally
How Co-Infection Is Managed
HIV treatment
ART should be started regardless of CD4 count. Effective HIV treatment with an undetectable viral load slows liver disease progression and improves hepatitis C treatment outcomes.
Hepatitis C treatment
Direct-acting antivirals (DAAs) cure hepatitis C in 8-12 weeks with cure rates above 95%, even in people with HIV. Common DAA combinations include sofosbuvir/velpatasvir (Epclusa) and glecaprevir/pibrentasvir (Maviret).
Drug interactions: Some DAAs interact with certain ART drugs. Your HIV specialist and hepatologist will coordinate regimens to avoid interactions. This is one of the main reasons co-infection should be managed at specialist centres.
Monitoring
- Regular liver function tests
- FibroScan or liver biopsy to assess fibrosis (liver scarring)
- Hepatitis C viral load monitoring during and after treatment
- Annual hepatitis C re-testing if ongoing risk factors (the cure doesn’t prevent reinfection)
Can You Be Reinfected with Hepatitis C After Cure?
Yes. Being cured of hepatitis C does not give you immunity. You can be reinfected if re-exposed. This is particularly relevant for people with ongoing risk factors (chemsex, needle sharing). Regular re-testing is recommended.
Testing
All people diagnosed with HIV should be tested for hepatitis C. Testing involves a blood test for hepatitis C antibodies, followed by an HCV RNA test if antibodies are positive (to confirm active infection). Order a home blood test.
Read more: What is HIV? | Hepatitis C overview
Frequently Asked Questions
Can hepatitis C be cured if you also have HIV?
Yes. DAA therapy cures hepatitis C in over 95% of co-infected patients. Having HIV does not reduce the cure rate with modern treatments.
Does treating hepatitis C improve HIV outcomes?
Yes. Curing hepatitis C reduces liver inflammation, slows liver disease progression, and reduces the risk of liver cancer. It also improves overall immune function and quality of life.
Related reading
- Blood Test for Syphilis, Hepatitis B and Hepatitis C
- Can You Die From Hepatitis B?
- What Is Hepatitis A?
- What Is Hepatitis B?
- Hepatitis B Core Antibody Test Explained
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
