HIV and Hepatitis B and C Coinfection

Hepatitis means inflammation of the liver. This condition is often caused by a virus. In the United States, the most common causes of viral hepatitis are hepatitis B virus (HBV) and hepatitis C virus (HCV). Because HBV and HCV can be spread in the same ways as HIV, people with HIV in the U.S. are often also affected by acute or chronic viral hepatitis.

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Viral hepatitis progresses faster and causes more liver-related health problems like liver cirrhosis, liver cancer, and end-stage liver disease 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 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 Common Are HIV and Hepatitis B or C Coinfections?

HIV/HBV Coinfection&#;About 2% of people with HIV in the United States are coinfected with HBV. People with HIV are at greater risk for complications and death from HBV infection.

HIV/HCV Coinfection&#;HCV infection is common among people with HIV who also inject drugs. Nearly 75% of people with HIV who report a history of injection drug use are co-infected with HCV. People with HIV are at greater risk for complications and death from HCV infection.

How Are Hepatitis B and C Spread?

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

• By sharing needles, syringes, and other equipment used to prepare and inject drugs.
• Perinatally: Pregnant people can pass these infections to their infants. Having HIV and HCV coinfection or HIV and HBV coinfection increases the risk of passing HCV or HBV 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 during anal intercourse among men who have sex with men, particularly for the receptive partner.

Learn about other ways that hepatitis B and hepatitis C are spread.

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 for adults from the Centers for Disease Control and Prevention (CDC) call for :

• One-time screening for all U.S. adults 18 years and older.
• Screening of all pregnant people during every pregnancy.
• One-time testing for all persons with risk factors, with testing continued periodic testing those with ongoing risk.
• Anyone who requests hepatitis C testing, regardless of disclosure of risk.
• Read more.

CDC&#;s HBV screening recommendations for adults call for:

• One-time screening for all U.S. adults 18 years and older using a triple panel test.
• Screening of all pregnant people during every pregnancy.
• Testing for all persons with risk factors, with testing continued periodic testing those with ongoing risk.
• Anyone who requests hepatitis B testing, regardless of disclosure of risk.
• Read more.

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 combination vaccine called Twinrix 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).

Learn more about Viral Hepatitis on HHS.gov.

What Is the Difference Between Hepatitis C and Hepatitis B?

Hepatitis is inflammation of the liver&#;an organ we depend on to digest nutrients, filter blood, and overcome infection. There are many different types of hepatitis, including hepatitis A, B, C, D, and E, with symptoms that include fever, abdominal pain, nausea, jaundice (yellowing of the skin and eyes), and fatigue.

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However, most people with chronic viral hepatitis do not experience any symptoms and often do not know they have the infection even while it silently damages their liver. Hepatitis B and C are among the most common types of hepatitis. While they both affect the liver, they are very different.

In this Q&A, Douglas Dieterich, MD, Professor of Medicine (Liver Diseases) and Director of the Institute for Liver Medicine at the Icahn School of Medicine at Mount Sinai, explains the differences between hepatitis C and B, how they are transmitted and treated, who is at risk, and more.

What is the difference between hepatitis C and B?

Hepatitis C virus (HCV) and hepatitis B virus (HBV) are vastly different viruses. Hepatitis B is highly contagious through sex, using drugs with shared straws and needles, blood transfusions, and even saliva, which can put people living in the same household at risk. The good news is hepatitis B is entirely preventable with a vaccine, which has been around since . The Centers for Disease Control and Prevention now recommends universal vaccination for hepatitis B for all adults under 60 who did not get vaccinated by their pediatrician starting in . People over 60 can also request the vaccine and should, especially if they have ongoing risk factors. If people do get hepatitis B, there are very good drugs to control it and to suppress the virus down to zero so it doesn&#;t do any damage or infect others. We also have exciting clinical trials happening to study medications that can cure Hepatitis B.

Currently, there is no vaccine for hepatitis C, which is a different class of virus. It actually belongs to a class that you may have heard of&#;West Nile virus, dengue fever, yellow fever, and Zika, which has been in the news the last few years. None of those become chronic, however, while hepatitis C does. Over time, it can cause the same liver damage that hepatitis B can, including liver cancer, which can lead to death. The good news is, it&#;s now easily curable.  We have fantastic new drugs for hepatitis C&#;most patients need to take only 8 to 12 weeks of easy-to-take pills with virtually no side effects and a 99 percent cure rate. It&#;s absolutely important to find out if you have hepatitis C or B because we can cure hepatitis C and control hepatitis B.

What do I need to know about hepatitis D?

Hepatitis D, also known as hepatitis Delta virus (HDV), is the most severe form of viral hepatitis. This is a type of hepatitis that can only infect people who have hepatitis B. Approximately 70 percent of people who have hepatitis Delta will develop cirrhosis (liver scarring) within 5 to 10 years of infection. This is a much higher and faster progression than for most people with hepatitis C and hepatitis B.

Hepatitis Delta can only function in a body that is also infected with hepatitis B. Not everyone with hepatitis B has hepatitis Delta, but everyone with hepatitis Delta also has hepatitis B. That&#;s why we recommend everyone with hepatitis B get screened for hepatitis Delta too.

New effective treatments for hepatitis Delta are coming soon and are already available to some patients, depending on their specific health situation. Our providers can screen you for hepatitis Delta and help get you onto treatment if needed.

Who is at risk for contracting hepatitis B and C, and who should get screened?

The CDC recommends all adults be screened for hepatitis B and C at least once in their life, even if they don&#;t think they have any risk factors. Many people have been exposed but don&#;t know it. The major method of transmission for hepatitis B, globally, is from mother to infant at birth. Other people who are at risk are those who have never been vaccinated&#;primarily people born before &#;and we see that happening now. When people born before come in contact with people who have hepatitis B, they can catch it quite easily. Hepatitis C is more difficult to catch. The major risks for hepatitis C are having had a transfusion of blood or blood products, such as gamma globulin, before , or using IV drugs or intranasal drugs. Just snorting drugs with a straw is enough to spread Hepatitis C. People who have unprotected sex&#;especially men who have sex with men&#;are also at risk for hepatitis C. It&#;s very important to get diagnosed early so you can get treated and cured. If you know you have ongoing risk factors, you should be screened at least once a year.

Why is hepatitis more common in New York City?

About 48 percent of the people who live in New York City were born outside of the United States. Many of those people come from countries where hepatitis B or C is endemic, and that&#;s the major risk factor for hepatitis B. Endemic means that a high percentage of people in an area have the disease and therefore the risk of getting the disease is high. The New York City Department of Health and Mental Hygiene estimates that 243,000 New Yorkers, or 2.9 percent of the population, have chronic hepatitis B. The Department also estimates that approximately 86,000 New Yorkers, or 1 percent of the population, have chronic hepatitis C.  If we catch viral hepatitis early, we can help you prevent liver scarring and liver cancer.

What is the best way to prevent hepatitis B and C?

The best way to prevent hepatitis B is to get vaccinated for hepatitis B. The CDC now recommends everyone aged 18 to 59 be vaccinated for hepatitis B. If you weren&#;t vaccinated as a kid, it&#;s easy to check if you have antibodies to hepatitis B, or if you have hepatitis B, we can treat that. Ask your doctor about testing and vaccination.

Hepatitis C is mostly spread blood to blood. Shared needles&#;if you&#;re using IV drugs, and shared straws if you&#;re using intranasal drugs&#;things like that&#;are really high risk for spreading hepatitis C. Getting a tattoo or piercing from an unlicensed technician may also put you at risk if they are not properly cleaning their needles. If you are using drugs, don&#;t share needles, don&#;t share straws. And get tested for hepatitis C, because if you have it, we can cure it. Once cured, you can become reinfected with hepatitis C, so it&#;s very important to continue avoiding infection after getting cured, which means not sharing needles or straws and practicing safe sex, and only getting tattoos and piercings from licensed technicians.

What resources are available at Mount Sinai for screening and treatment of hepatitis?

We have numerous resources dedicated to screening and treatment of hepatitis B and hepatitis C at Mount Sinai. We&#;re the largest independent liver program in the country. We have liver clinics all over Manhattan and the metropolitan area&#;from Long Island to Westchester.  Our care coordinators will support you from screening through treatment and cure, working closely with your provider to ensure you get the best care.

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