Yes. If you have chronic hepatitis C or hepatitis B—two viral infections that can cause the liver to become inflamed and damaged—you can take HIV medications. However, it is important to understand that there may be a higher risk of liver damage occurring if you have either of these infections and are taking ARV medications.
While there have been a number of studies looking at rates of hepatotoxicity among people coinfected with both HIV and hepatitis C or hepatitis B who are taking HIV drugs, the results often conflict with one another. For example, one study conducted by the San Francisco Community Health Network demonstrated that Viramune (nevirapine) was the only anti-HIV medication to significantly increase the risk of hepatotoxicity in people coinfected with HIV and either hep C or hep B. But there have also been study results suggesting that Viramune is no more or less likely to cause hepatotoxicity in coinfected patients than other anti-HIV medications, although it's still important to watch out for liver enzyme increases during the first three months of Viramune treatment.
As for the protease inhibitors, there have been a few studies demonstrating that Norvir (ritonavir) is the most likely to cause hepatotoxicity in HIV-positive people coinfected with hep C or hep B. However, Norvir is rarely used at the approved dose (600 mg twice a day)—much lower doses of Norvir are usually used (100 or 200 mg twice a day), as it is now most frequently prescribed to boost other protease inhibitor levels in the bloodstream. This, in turn, likely decreases the risk of hepatotoxicity in people who are only infected with HIV or coinfected with HIV and either hep C or hep B. Extra caution is also suggested when people with HBV or HCV use either Aptivus or Prezista, especially if they have even moderate liver damage already.
If one thing is clear, it is that people who are coinfected with HIV and either hep C or hep B should work closely with their doctors to come up with safe and effective treatment plans. For example, many experts now believe that, if you have HIV and hep C, you should consider starting hep C treatment while your CD4 cell counts are high, before treatment is needed for HIV. Successfully treating or controlling HCV is, perhaps, the best way to reduce the risk of hepatotoxicity once ARV medications are started.
To learn more about hepatitis C and its treatments, check out the following lesson:
Hepatitis C
It is also important to monitor your liver carefully while taking ARV medications. You'll want to find out the levels of your liver enzymes before you begin taking anti-HIV medications. Even if they are higher than normal because of either hep C or hep B, you can then monitor your levels closely while on treatment.
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