Consider whether the patient has hepatitis B or HIV co-infection

Patients with hepatitis C may also be infected with hepatitis B virus (HBV) or HIV. Hepatitis C and hepatitis B are indicator conditions for HIV testing¹. If hepatitis C or hepatitis B is identified, offer HIV testing, regardless of whether the patient has behavioural or epidemiological risk factors for HIV infection.

In patients with HCV–HBV co-infection, there is a risk of hepatitis B reactivation following direct-acting antiviral treatment for hepatitis C, so initiation of hepatitis B therapy may be required before starting therapy for hepatitis C.

In patients with HCV–HIV co-infection, drug interactions can be challenging to manage.

Patients with HBV or HIV co-infection should be referred for specialist management.