HIV and Hepatitis B and Hepatitis C Coinfection

Hepatitis B and hepatitis C are liver infections caused by a virus. Because these infections can be spread in the same ways as HIV, people with HIV in the United States are often also affected by chronic viral hepatitis.

Viral hepatitis progresses faster and causes more liver-related health problems among people with HIV than among those who do not have HIV. Liver disease, much of which is related to HBV or HCV, is a major cause of non-AIDS-related deaths among people with HIV.

Given the risks of hepatitis B or hepatitis C coinfection to the health of people with HIV, it is important to understand these risks, take steps to prevent infection, know your status, and, if necessary, get medical care from a health care provider who is experienced in treating people who are coinfected with HIV and HBV, or HIV and HCV.

How Are Hepatitis B and Hepatitis C Spread from Person to Person?

Like HIV, the hepatitis B and hepatitis C viruses spread:

• By sharing needles, syringes, and other injection equipment.
• Perinatally: Pregnant people can pass these infections to their infants. HIV-HCV coinfection increases the risk of passing on hepatitis C to the baby.
• Sexually: Both viruses can also be transmitted sexually, but HBV is much more likely than HCV to be transmitted sexually. Sexual transmission of HCV is most likely to happen among gay and bisexual men who have HIV.

Is Hepatitis Testing Recommended for People with HIV?

Yes. Everyone with HIV should be tested for HBV and HCV when they are first diagnosed with HIV and begin treatment. People with HIV who have ongoing risk factors for getting hepatitis B or hepatitis C should be tested annually.

In addition, HCV screening recommendations from the Centers for Disease Control and Prevention (CDC) call for:

• One-time screening for all adults 18 years and older
• Screening of all pregnant women during every pregnancy
• Testing for all persons with risk factors, with testing continued periodic testing those with ongoing risk.

How Can You Prevent Hepatitis B and Hepatitis C?

Hepatitis B: Vaccination is the best way to prevent all the ways that hepatitis B is transmitted. People with HIV who do not have active HBV infection should be vaccinated against it. The hepatitis B vaccine is now recommended for all infants, children and adults ages 19-59, as well as adults ages 60+ at high risk for infection. There is a 3-dose series of hepatitis B vaccine given over 6 months, and a 2-dose series given over 1 month. Additionally,  there  is a 2-dose combination vaccine that protects against both hepatitis A and hepatitis B. (Find a vaccine near you.)

Hepatitis C: No vaccine exists for HCV and no effective pre- or post-exposure prophylaxis is available. Injection drug use is one of the risk factors for hepatitis C. For people who inject drugs, the best way to prevent hepatitis C infection is to always use new, sterile needles or syringes, and never reuse or share needles or syringes, water, or other drug preparation equipment. Community-based prevention programs, such as medication-assisted treatment (MAT) and syringe services programs (SSPs) provide support and services aimed at preventing and reducing the transmission of HCV. Although the risk of sexual transmission of HCV is considered to be low, avoiding unprotected sexual exposure by using condoms has been shown to reduce the chance of sexually transmitted infections.

Treatment for HIV-Hepatitis Coinfections

HIV-HBV and HIV-HCV coinfections can be effectively treated in most people. But medical treatment can be complex, and people with coinfection should look for health care providers with expertise in the management of both HIV infection and viral hepatitis.

Hepatitis B: For hepatitis B, treatment can delay or limit liver damage by suppressing the virus. Like treatment for HIV, hepatitis B treatment may need to be taken for the rest of your life. Some HIV medications can also treat hepatitis B. If you are diagnosed with hepatitis B, your health care provider will go over which treatment regimen is best for you.

Hepatitis C: Hepatitis C is a curable disease. Left untreated, it can cause severe liver damage, liver cancer, or death. However, new treatments for hepatitis C have been approved in recent years. These direct-acting antiviral treatments are much better than the previously available treatment because they have few side effects and do not need to be injected. These treatments for HCV infection cure about 97% of people, including those living with HIV, with just 8-12 weeks of oral therapy (pills).