Hepatitis is a virus that affects the liver. Human immunodeficiency virus (HIV), mostly infects CD4 cells, also known as T cells. These white blood cells coordinate the immune system to fight disease. AIDS (acquired immune deficiency syndrome) is a condition caused by HIV.
When someone with chronic hepatitis B virus infection (HBV) is also living with HIV, the term used is HIV/HBV coinfection. According to the Centers for Disease Control and Prevention (CDC), about 10 percent of people with HIV are coinfected with hepatitis B.
HIV can worsen hepatitis B. People who are coinfected with HIV and HBV are at increased risk for liver damage and related life-threatening complications. This damage tends to occur more quickly in people who are coinfected with HIV and hepatitis B.
Although antiretroviral treatment has improved the health and extended the life expectancy of people with HIV, liver disease related to viral hepatitis increases the risk of non-AIDS-related deaths in those who are coinfected with HIV/HBV. Further, the presence of viral hepatitis can complicate the management of HIV. It is important for people with HIV/HBV to work closely with their health care providers in order to monitor and treat both conditions safely and effectively.
Although a number of medications are used to treat hepatitis B, some specific treatments are recommended for people who are coinfected with HIV. Click here for the current treatment guidelines from the Association for the Study of Liver Diseases for people coinfected with HIV and hepatitis B.
It is very important that people with chronic hepatitis B take their medications exactly as prescribed. Missing doses can cause HBV to become resistant to HBV medications. Prematurely stopping HBV medications can also cause HBV viral load and liver enzymes to quickly increase, which can damage the liver and cause severe symptoms. This can also happen in people who have HBV who develop resistance to the medications they are using. In turn, for people with chronic hepatitis B who are receiving treatment, it is very important to be monitored frequently and carefully by a health care provider.
When someone with hepatitis C virus infection (HCV) is also living with HIV, the term used is HIV/HCV coinfection. In the United States, approximately 25 percent of people living with HIV are coinfected with HCV. This means that about 225,000 to 330,000 people in the United States are living with both viruses.
HIV is transmitted through the following body fluids: blood, semen, pre-cum, rectal fluids, vaginal fluids and breast milk. To learn more about HIV transmission, click here.
Hepatitis C (HCV) is most easily spread through direct blood-to-blood contact and is transmitted when the blood of an infected person passes into the blood of an uninfected person. To learn more about HCV transmission, click here.
People who use injection drugs and who have shared needles or other injection equipment—including cookers, cotton and measuring syringes—are at the highest risk of being infected with hepatitis C. Roughly 75 percent of people who are infected with HIV from injecting drugs are also infected with HCV. This is because both viruses can be spread easily through blood and blood products.<
While sexual transmission of hep C is relatively rare, being HIV positive appears to increase the risk for acquiring hepatitis C sexually. Researchers have found some common risks—along with HIV itself—that are associated with these sexually transmitted outbreaks, such as:
· Participating in group sex
· Finding sex partners on the Internet
· Rougher, longer anal intercourse (receptive and insertive)
· Receptive or insertive fisting
· Shared sex toys
· Non-injection drug use (nasal or anal)
· Having another sexually transmitted infection
HIV may increase the risk of sexually transmitted hepatitis C infection among women. HIV-positive women who have a male partner who uses injection drugs are more likely to be coinfected with hepatitis C than HIV-negative women who have a male partner who uses injection drugs.
Coinfected women can pass hepatitis C to their infants during pregnancy, labor and delivery. The risk for mother-to-infant transmission of HCV is around 6 percent in women with HCV alone. When HIV is present, the HCV transmission risk doubles or triples. Although antiretroviral therapy reduces the risk for HIV transmission from mother to child, it is not clear whether it lowers the risk of hepatitis C transmission. What’s more, delivering a baby via caesarean section, compared with vaginal delivery, does not appear to reduce the risk of mother-to-child HCV transmission. Breastfeeding is known to transmit HIV, and it may increase the risk of HCV transmission when the mother is living with both viruses.
Some HIV-positive people can clear HCV by a strong immune response, or with treatment. It is possible, however, for a person who ultimately clears the virus—either spontaneously or through treatment—to become reinfected with hepatitis C.
Hep C can cause lifelong infection, and over time it can cause fibrosis (mild to moderate liver scarring), cirrhosis (serious liver scarring), liver cancer, liver failure and death. HIV can worsen hepatitis C. Not only does HIV increase the risk of liver damage, but it can also speed up the onset of liver damage following infection.
Many medications used to treat HIV, including the protease inhibitors and the non-nucleoside reverse transcriptase inhibitors, are broken down (metabolized) by the liver and can cause liver injury, even in people who aren’t living with hepatitis C. People taking ARVs should have their liver enzymes monitored regularly. Choosing HIV medications that are known to be easy on the liver and are less likely to interact with hep C treatments is the best solution. It is important for people who are coinfected with HIV and HCV to work closely with their health care providers in order to monitor and treat both conditions safely and effectively.
The goal of hepatitis C treatment is to cure the virus, which can be done by using a combination of drugs. Having HIV does not affect a person’s chances of becoming cured. The length of treatment, which ranges from 8 to 24 weeks, depends on the person’s HCV genotype (genetic structure of the virus), whether or not they have been treated before, if they have liver cirrhosis, and the level of virus in the body (known as viral load). Successful hepatitis C treatment is defined as an undetectable HCV viral load 12 weeks after completing treatment. This is called a sustained virologic response, or SVR.
A cure typically stops the advancement of liver scarring (called fibrosis), and may even send it in reverse to an extent. Ridding yourself of the virus also reduces, but does not necessarily eliminate, the raised risk of future health complications resulting from hep C, including cirrhosis, liver cancer, liver failure and death. The risks of such outcomes are higher if they already have severe liver scarring or cirrhosis, despite being cured of hepatitis C
Research has suggested that people who are living with both HIV/HCV coinfection tend to experience faster progression of hep C-related complications than those who only have hep C. The American Association for the Study of Liver Diseases (AASLD) says that people with hep C who are coinfected with HIV should be prioritized for HCV treatment.
There are a number of highly effective treatments currently approved by the U.S. Food and Drug Administration (FDA) to treat hep C. Click here for the AASLD-recommended regimens for those who are coinfected with HIV.
Some of the hepatitis C drugs have been shown to interact negatively with HIV antiretrovirals. This is called a drug-drug interaction. It’s important to discuss your HCV treatment options with your physician based on your HIV regimen. Luckily, with the hep C therapies available today, the opportunities for safe and effective treatment when someone is being treated for HIV are quite broad.
Hepatitis A vaccination is recommended for people who have not had hep A.
If you are living with HBV and are NOT coinfected with HIV, visit the Hepatitis B Basics on the diagnosis, monitoring and treatment of hepatitis B.
If you are living with HCV and are NOT coinfected with HIV, visit the Hepatitis C Basics on the diagnosis, monitoring and treatment of hepatitis C.
If you are living with HIV and are NOT coinfected with HBV, vaccination against hepatitis B is highly recommended. For information on the diagnosis, monitoring and treatment of HIV, visit the POZ Basics.
If you are living with HIV and are NOT coinfected with HCV, visit the POZ Basics on the diagnosis, monitoring and treatment of HIV.
Last Reviewed: July 19, 2023