Information in this guide is based on the following treatment guidelines. These guidelines are all available free online and are fully referenced.

European AIDS Clinical Society (EACS). Guidelines included management of HBV and HCV co-infection in HIV positive people (2016)

European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatitis C virus infection (2016).

AASLD/IDSA. Hepatitis C guidance: AASLD-IDSA recommendations for testing, managing, and treating adults infected with hepatitis C virus. (2016)

BHIVA Guidelines for the clinical management hepatitis viruses in HIV positive adults (2013). HIV Medicine (2013), 14 (Suppl. 4), 1–71.

BHIVA. Management of HIV infection in pregnant women (2012, 2014 update)

Drug interactions

For drug interactions with HCV medications please see the comprehensive interactive resource from Liverpool University Department of Pharmacology.

Other references

A limited selection of additional references are also included below, organised below by main subject.


Turner J et al. The prevalence of hepatitis C virus (HCV) infection in HIV positive individuals in the UK – trends in HCV testing and the impact of HCV on HIV treatment outcomes.  Journal of Viral Hepatitis, 2010 Aug;17(8):569-77.

Armstrong L et al. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006;144:705–714.

Alter M. Hepatitis C virus infection in the United States. J Hepatol. 1999;31:88–91.


Paintsil E et al. Hepatitis C virus maintains infectivity for weeks after drying on inanimate surfaces at room temperature: implications for risks of transmission. J Infect Dis. (April  2014) 15;209(8):1205-11. doi: 10.1093/infdis/jit648. Epub 2013 Nov 23.

Doerrbecker J et al. Inactivation and survival of hepatitis C virus on inanimate surfaces. J Infect Dis. (December 2011) 204(12):1830–8. doi: 10.1093/infdis/jir535.

Thibault V et al. Hepatitis C transmission in injection drug users: could swabs be the main culprits? J Infect Dis (2011) 204(12): 1839-42. doi: 10.1093/infdis/jir650. Epub 2011 Oct 19.

Kamili S et al. (2007) Infectivity of hepatitis C virus in plasma after drying and storing at room temperature. Infect Control Hosp Epidemiol 28: 519–524.
Study reporting the continued infectiousness of HCV in the environment.

Risk of nasal route of transmission (shared cocaine straws):
Trimarchi M et al. (2006) Massive apoptosis erodes nasal mucosa of cocaine users. Am J Rhinol 2006, Mar-Apr;20(2):160-4. 

Aaron S et al. (2008) Intranasal transmission of hepatitis C virus: virological and clinical evidence. Clin Infect Dis 47: 931–934.

Reduced immune responses to HCV

Danta M et al. Impact of HIV on host-virus interactions during early hepatitis C virus infection. Journal of Infectious Diseases 2008; 197:1558 – 1566.

Schnuriger A  et al. Acute hepatitis C in HIV-infected patients: rare spontaneous clearance correlates with weak memory CD4 T-cell responses to hepatitis C virus. AIDS. 2009 Oct 23;23(16):2079-89. doi: 10.1097/QAD.0b013e328330ed24.

Thomson EC  et al. Predicting spontaneous clearance of acute hepatitis C virus in a large cohort of HIV-1-infected men. Gut 2011; June; 60(6): 837–845. doi:  10.1136/gut.2010.217166.

Sexual HCV transmission

HCV in vaginal fluid:
Nowicki MJ et al. Presence of hepatitis C virus (HCV) RNA in the genital tracts of HCV/HIV-1 coinfected women. J Infect Dis. (2005) November 1; 192(9): 1557–1565. doi:  10.1086/491742.

Page-Shafer KA et al. Hepatitis C virus infection in young,  low-income women: the role of sexually transmitted infection as a potential cofactor for HCV infection. Am J Public Health. 2002 April; 92(4): 670–676.

HCV in semen:
Pekler VA et al. Use of versant TMA and bDNA 3.0 assays to detect and quantify hepatitis C virus in semen. J Clin Lab Anal 2003; 17:264–270.

Luruez-Ville M et al. Detection of hepatitis C virus in the semen of infected men. Lancet. 2000;356:42–43.

Pasquier C et al. Intermittent detection of hepatitis C virus (HCV) in semen from men with human immunodeficiency virus type 1 (HIV-1) and HCV. J Med Virol. 2003;69:344–349.

Nyamathi A et al. Presence and predictors of hepatitis C virus RNA in the semen of homeless men. Biol Res Nurs. 2002;4:22–30.

Briat A et al. Hepatitis C virus in the semen of men co-infected with HIV-1: Prevalence and origin. AIDS. 2005;19:1827–1835.

Heterosexual transmission:
Frederick T et al. Factors associated with prevalent hepatitis C infection among HIV-infected women with no reported history of injection drug use: the Women’s Interagency HIV Study (WIHS). AIDS Patient Care STD: 2009 November; 23(11): 915–923. DOI: 10.1089=apc.2009.0111,  (PDF download)

Neumayr G et al. Sexual transmission of hepatitis C. Hepatitis C Information Central. 2007.

Low rates of heterosexual transmission:
Weisbord J et al. Prevalence of and risk factors for hepatitis C virus infection among STD clinic clientele in Miami, Florida. Sex Transm Infect. 2003;79:

Terrault NA. Sexual activity as a risk factor for hepatitis C. Hepatology. 2002;36:S99–S105.

Feldman J et al. Heterosexual transmission of hepatitis C, hepatitis B, and HIV-1 in a sample of inner city women. Sex Transm Dis. 2000;27:338–342.

Rooney G. Gilson RJ. Sexual transmission of hepatitis C virus infection. Sex Transm Infect.1998;74:399–404.

In gay men/MSM:
Bradshaw D et al. Sexually transmitted hepatitis C infection: the new epidemic in MSM? Current Opinion, Volume 26, Number 1, February 2013.
Full article access.

Larsen C et al. Gaining greater insight into HCV emergence in HIV-infected men who have sex with men: The HEPAIG Study. PLoS One 2011; 6:e29322.

Richardson D et al. Sexual transmission of hepatitis C in MSM may not be confined to those with HIV infection. J Infect Dis 2008; 197:1213–1214.

Reports of sexual HCV transmission in HIV negative MSM:
Danta M et al. Recent epidemic of acute hepatitis C virus in HIV-positive men who have sex with men linked to high-risk sexual behaviours. AIDS 2007; 21:983–991.

An important case control study:
Schmidt AJ et al. Trouble with bleeding: risk factors for acute hepatitis C among HIV-positive gay men from Germany-a case-control study. PLoS ONE (2011); 6(3):e17781.

van de Laar T et al. Evidence of a large, international network of HCV transmission HIV-positive men who have sex with men. Gastroenterology. 2009;136:1609–1617.

Drug interactions

Some recreational drugs may have interactions with HIV drugs. For more information see:

OSI Report. Delivering HIV care and treatment for people who use drugs. (July 2006).


Kelly EM et al. Moderate Alcohol use is not Associated with Fibrosis Progression in HIV/HCV Co-Infected Women: A Prospective Cohort Study. Clinical Infectious Diseases, cix716. DOI: 10.1093/cid/cix716. (16 August 2017).

Lo Re V. Is Moderate Alcohol Consumption Safe for HIV/Hepatitis C Virus-Coinfected Women? Clinical Infectious Diseases, cix720. (16 August 2017).


Macías J et al.Changes in Liver Steatosis After Switching From Efavirenz to Raltegravir Among Human Immunodeficiency Virus–Infected Patients With Nonalcoholic Fatty Liver Disease. Clinical Infectious Diseases, Volume 65, Issue 6, 15 September 2017, Pages 1012–1019. (31 July 2017)

Last updated: 17 August 2017.