HIV vs HCV: similarities and differences

Characteristic	HIV	HCV
Type of virus and how transmitted	Blood borne. Also present in semen, vaginal fluid and breast milk	Blood borne. Also may be present in semen and vaginal fluid
Whether sexual transmission occurs	Sexual transmission common	Sexual transmission less common, especially among heterosexual couples, but does occur among HIV positive gay men
Risk of mother-to-child transmission (MTCT)	Risk of mother-to-child transmission can be dramatically reduced with use of antiretroviral therapy	Risk of MTCT of HCV is higher if you are HIV positive. In the UK, women with coinfection are only recommnded to have an elective C-section to lower the risk if they have a detectable HIV viral load or have complications.
Risk from breastmilk	Breast feeding can transmit HIV	Risk of HCV transmission from breast feeding is considered very low (unless mother’s nipples are cracked or bleeding)
Whether lifelong	Yes (at time of writing)	No. For most people HCV can be cleared/cured (using DAAs).
Risk of reinfection	Reinfection with HIV happens. In many cases it may not have serious implications unless the new virus is drug resistant (cases of reinfection with drug-resistant HIV have been reported, but no one is sure how often this happens). HIV reinfection is the subject of current research.	Reinfection with hepatitis C occurs, and being reinfected with a different genotype may make it more difficult to treat. For example, if someone with HCV genotype 2 is reinfected with HCV genotype 1. Clearing the virus with a natural immune response or with treatment doesn’t protect you from reinfection in the future.
How infectious outside the body	HIV is a fragile virus. Dies quickly when outside of the human body	HCV is a tougher virus. Can live for days outside of the human body.
Is treatment always needed?	Treatment is not always necessary, but it is needed by the majority of people at some time. Less than 5% people still have not needed to start treatment 15 years after infection.	Treatment is not always necessary. Some people clear the virus naturallly and some people do not get symptoms even in chronic infection.
Speed of progression	People can live with HIV for many years without symptoms (average 5-8 without treatment).	People can live with HCV for many years without symptoms (average over 10-15 for people with coinfection).
Effect of treatment on viral load	Levels of HIV in the blood can be suppressed by treatment.	HCV can be virtually eradicated from the bloodstream if treatment is successful.
Duration of treatment	Treatment is expected to be lifelong.	Treatment usually lasts for a year or less.
Impact of viral load on how fast the disease progressed	Viral load is linked to disease progression.	Viral load is linked to treatment response (with pegylated interferon and ribavirin), but not disease severity or progression. Viral load may be less important with DAAs.
Choice of treatment	More than 26 drugs available, that specifically target the virus.	Currently, standard of care is combination therapy with pegylated interferon plus ribavirin, plus an HCV protease inhibitor for genotype 1. New DAAs that direct target HCV are expected to change treatment options in the next two years.
Research pipeline	Drugs from new classes and existing classes are currently in development.	Drugs from new and existing classes are currently in development.

Characteristic

HIV

HCV

Type of virus and how transmitted

Blood borne. Also present in semen, vaginal fluid and breast milk

Blood borne. Also may be present in semen and vaginal fluid

Whether sexual transmission occurs

Sexual transmission common

Sexual transmission less common, especially among heterosexual couples, but does occur among HIV positive gay men

Risk of mother-to-child transmission (MTCT)

Risk of mother-to-child transmission can be dramatically reduced with use of antiretroviral therapy

Risk of MTCT of HCV is higher if you are HIV positive. In the UK, women with coinfection are only recommnded to have an elective C-section to lower the risk if they have a detectable HIV viral load or have complications.

Risk from breastmilk

Breast feeding can transmit HIV

Risk of HCV transmission from breast feeding is considered very low (unless mother’s nipples are cracked or bleeding)

Whether lifelong

Yes (at time of writing)

No. For most people HCV can be cleared/cured (using DAAs).

Risk of reinfection

Reinfection with HIV happens. In many cases it may not have serious implications unless the new virus is drug resistant (cases of reinfection with drug-resistant HIV have been reported, but no one is sure how often this happens). HIV reinfection is the subject of current research.

Reinfection with hepatitis C occurs, and being reinfected with a different genotype may make it more difficult to treat. For example, if someone with HCV genotype 2 is reinfected with HCV genotype 1. Clearing the virus with a natural immune response or with treatment doesn’t protect you from reinfection in the future.

How infectious outside the body

HIV is a fragile virus. Dies quickly when outside of the human body

HCV is a tougher virus. Can live for days outside of the human body.

Is treatment always needed?

Treatment is not always necessary, but it is needed by the majority of people at some time. Less than 5% people still have not needed to start treatment 15 years after infection.

Treatment is not always necessary. Some people clear the virus naturallly and some people do not get symptoms even in chronic infection.

Speed of progression

People can live with HIV for many years without symptoms (average 5-8 without treatment).

People can live with HCV for many years without symptoms (average over 10-15 for people with coinfection).

Effect of treatment on viral load

Levels of HIV in the blood can be suppressed by treatment.

HCV can be virtually eradicated from the bloodstream if treatment is successful.

Duration of treatment

Treatment is expected to be lifelong.

Treatment usually lasts for a year or less.

Impact of viral load on how fast the disease progressed

Viral load is linked to disease progression.

Viral load is linked to treatment response (with pegylated interferon and ribavirin), but not disease severity or progression. Viral load may be less important with DAAs.

Choice of treatment

More than 26 drugs available, that specifically target the virus.

Currently, standard of care is combination therapy with pegylated interferon plus ribavirin, plus an HCV protease inhibitor for genotype 1. New DAAs that direct target HCV are expected to change treatment options in the next two years.

Research pipeline

Drugs from new classes and existing classes are currently in development.

Drugs from new and existing classes are currently in development.