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Hepatitis

People living with HIV are at increased risk for viral hepatitis and should be tested Viral hepatitis is a leading cause of serious liver problems and liver cancer. And progresses faster among people living with HIV. People at high risk for HIV infection - including men who have sex with men and injection drug users - should be vaccinated against hepatitis a and b (there is no hepatitis c vaccine)
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what is Hepatitis?

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 A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV). HBV and HCV are common among people who are at risk for or living with HIV; that’s because these viruses are transmitted in some of the same ways HIV is transmitted—through injection drug use and condomless sex. When someone is infected with both HIV and viral hepatitis, we say that they are “coinfected.”

Viral hepatitis progresses faster and causes more liver-related health problems among people with HIV than among those who do not have HIV. Although drug therapy has extended the life expectancy of people with HIV, liver disease—much of which is related to HCV and HBV—has become the leading cause of non-AIDS-related death among people living with HIV.

Hepatitis A and HIV

  • Hepatitis A is preventable with a vaccine, and the vaccine is recommended for people at high risk for or living with HIV infection.
  • There is no antiviral treatment for HAV-infection, but most HAV-infected people recover completely.

Hepatitis A is a contagious, but usually short-term liver disease that results from infection with HAV. HAV infection usually makes adults sick with symptoms including fever, fatigue, nausea, and jaundice and is more severe in people who have HBV and/or HCV.

Transmission

HAV is usually spread from person to person when the virus is ingested through contact with food, drinks, or objects (including injection drug equipment) that have been contaminated by the feces of an HAV-infected person.

Vaccine to Prevent Hepatitis A

There is a vaccine that can prevent HAV infection. The HHS Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents recommend HAV vaccination for people living with HIV who are also at risk for HAV infection, including people who have chronic liver disease, MSM, users of injection drugs, and those who are coinfected with HBV and/or HCV.  CDC also recommends HAV vaccination for people at high risk for HIV infection, including men who have sex with men (MSM), users of recreational drugs (whether injected or not), and sex partners of people who have HAV infection.

Treatment

There is no treatment for HAV infection, but almost all people who get HAV recover completely and do not have any lasting liver damage, although they may feel sick for months.

For more information, see CDC’s Hepatitis A Information for the Public.

Hepatitis B and HIV

  • About 10% of people living with HIV in the U.S. are coinfected with HBV.
  • All people living with HIV should be tested for HBV.
  • People living with HIV who are coinfected with HBV are at increased risk for serious, life-threatening health complications. HIV/HBV coinfection can also complicate the management of HIV infection.
  • Hepatitis B is preventable with a vaccine and HBV vaccination is recommended for people who are at risk for or living with HIV who have tested negative for HBV.

Hepatitis B is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness. It results from infection with HBV.

You can have HBV without having any symptoms, and sometimes it will clear up naturally without progressing to a chronic infection, leaving you with immunity. People who have chronic HBV infection, however, can develop liver disease, liver failure, or even liver cancer. HBV is the world’s leading cause of chronic liver disease.

Transmission

HBV is transmitted through contact with infectious blood, semen, or other body fluids; sexual contact with an HBV-infected person; sharing of contaminated needles, syringes, or other drug injection equipment (i.e., “works”); and needlesticks or other sharp-instrument injuries. A woman who is infected with HBV can also pass HBV to her newborn.

Testing

There is a test that can detect if you have HBV, even if you have no symptoms. The test result can help determine if you have ever been infected with HBV, and if so, whether you have chronic HBV infection or you have cleared the virus on your own.  Your provider can determine whether you would benefit from HBV vaccination. People living with HIV who are coinfected with HBV are at increased risk for serious, life-threatening health complications. HIV/HBV coinfection can also complicate the management of HIV infection. For this reason, HHS’ Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, HRSA’s Clinical Guide for HIV/AIDS Care, and the CDC all recommend that all people living with HIV get tested for HBV. 

Vaccine to Prevent Hepatitis B

There is a vaccine that can protect you from HBV. If your hepatitis B test is negative - -meaning that you don’t have chronic hepatitis B and you don’t have antibodies against hepatitis B – your healthcare provider will recommend that you get the hepatitis B vaccine to prevent infection. The CDC recommends HBV vaccination for people who are at risk for or living with HIV, including MSM; people who inject drugs; household contacts and sex partners of people who have HBV; people with multiple sex partners; anyone with a sexually transmitted infection; and health care and public safety workers exposed to blood on the job.

Treatment

If your hepatitis B test is positive, your healthcare provider will discuss treatment for this coinfection with you. Treatment for HBV infection involves using antiviral medications, some of which are the same as those that treat HIV.  HBV treatment can delay or limit the effects of liver damage. HBV/HIV coinfection can be effectively treated in many people, but treatment is complex. If you have HIV/HBV coinfection, you should look for a healthcare provider with expertise in the management of both infections.

If you have HIV/HBV coinfection, you should also ask your healthcare provider if you need to be immunized against HAV to prevent further infection and liver damage, and ask about other lifestyle changes you may need to make, such as avoiding the use of alcohol, as this can cause additional liver damage. You should also check with your healthcare provider before taking any prescription pills, supplements, or over-the-counter medicines, as these can potentially damage your liver.

Preventing the Spread of HBV to Others

If you are coinfected with HBV, it is important to remember that the use of latex condoms not only reduces your risk of transmitting HIV to sexual partners but reduces the risk of transmitting viral hepatitis infections to others as well.  In addition, because HBV is transmitted from infected person to uninfected person through blood and bodily fluids, be sure to avoid sharing needles, razors, and toothbrushes.

For more information, see CDC’s Hepatitis B Information for the Public.

Hepatitis C and HIV

  • About 25% of people living with HIV in the U.S. are coinfected with HCV, and about 80% of people with HIV who inject drugs also have HCV.
  • HIV coinfection more than triples the risk for liver disease, liver failure, and liver-related death from HCV. Coinfection can also complicate the management of HIV infection.
  • All people living with HIV should be tested for HCV.
  • There is no vaccine for HCV, but treatment is available.
  • Hepatitis C treatments can cure HCV and these treatments are improving, with fewer side effects and shorter length of treatment than in the past.

Hepatitis C is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness that attacks the liver. It results from infection with HCV.

HCV is one of the most common coinfections associated with HIV. According to CDC, about 25% of people living with HIV in the United States are coinfected with HCV, and about 80% of people with HIV who inject drugs are coinfected with HCV.

Transmission

HCV is most commonly transmitted through contact with the blood of an HCV-infected person, primarily through sharing contaminated needles, syringes, or other drug use equipment. Less commonly, it is transmitted through sexual contact with an HCV-infected person, birth to an HCV-infected mother, or needlesticks or other sharp-instrument injuries.

Testing

If you have HCV, you may not have any symptoms. Chronic HCV is often “silent,” meaning that you can have the infection for decades without having symptoms or feeling sick. During that time, however, the virus is damaging your liver.

In order to diagnose HCV, you will need to first have an antibody test (blood test).  If the antibody test comes back positive, you will need to have a follow-up test to confirm current infection and/or measure the amount of HCV in your blood. In addition, you may need to have additional procedures to determine whether you have liver damage and how serious it is.

HIV/HCV coinfection more than triples the risk for liver disease, liver failure, and liver-related death from HCV. HIV/HCV coinfection can also complicate the management of your HIV infection. For this reason, HHS’ Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents, HRSA’s Clinical Guide for HIV/AIDS Care, and the CDC recommend that all people living with HIV get tested for HCV. Also, if you are engaged in behaviors that put you at risk for HCV (see “Transmission” above), talk to your healthcare provider about periodic retesting to make sure you have not been exposed to the virus since your last test.

Treatment

There is no vaccine to prevent HCV, but HCV can be treated with antiviral medications. Many people infected with HCV experience a cure or clearance of the virus as a result of treatment. Not everyone is a good candidate for this treatment, so you will need to talk with your healthcare provider to find out whether you will benefit. Newly approved HCV treatments are available that are taken for a shorter period of time, have fewer side effects, and are more effective than treatments used in the past. Treatment is complex, so if you have HIV/HCV coinfection, you should look for a healthcare provider with expertise managing both infections.

If you have HIV/HCV coinfection, you should also ask your healthcare provider if you need to be immunized against HAV and HBV to prevent further infections and liver damage, and ask about other lifestyle changes you may need to make, such as avoiding the use of alcohol, as this can cause additional liver damage. You should also check with your healthcare provider before taking any prescription pills, supplements, or over-the-counter medicines, as these can potentially damage your liver.

Preventing the Spread of HCV to Others

If you are coinfected with HCV, it is important to remember that the use of latex condoms not only reduces your risk of transmitting HIV to sexual partners but reduces the risk of transmitting viral hepatitis infections as well.  In addition, because HCV is transmitted from infected person to uninfected person through blood and bodily fluids, be sure to avoid sharing needles, razors, and toothbrushes.

For more information, see CDC’s Hepatitis C Information for the Public.

Protecting Yourself From Viral Hepatitis

People living with HIV who test negative for HBV and HCV can take steps to protect themselves from acquiring these viral infections.

The best way to prevent HAV and HAB infection is to get vaccinated.  Because there is no vaccine for HCV, the best way to prevent HCV infection is to never inject illegal drugs or to stop injecting illegal drugs if you currently do so by getting into and staying in a drug treatment program. If you continue injecting drugs, always use new, sterile syringes and never reuse or share syringes, needles, water, or other drug preparation equipment (“works”).

You can find a drug treatment program by using the HIV Testing and Care Services Locator. Simply click on the “Service Locator” box in the lower right corner of this page, then enter your ZIP Code in the page that appears.

If you are living with HIV, you also can lower your risk of contracting hepatitis and other bloodborne viruses by not sharing toothbrushes, razors, or other personal items that may come into contact with another person’s blood. Do not get tattoos or body piercings from an unlicensed facility or in an informal setting, which may use dirty needles or other instruments, as these can put you at risk for hepatitis.

Frequently Asked Questions

Why is viral hepatitis so dangerous for people living with HIV?

Viral hepatitis progresses faster and causes more liver-related health problems among people with HIV than among those who do not have HIV. Left untreated, HBV and HCV can cause long-term illness and death. Coinfection with hepatitis may also complicate the management of HIV infection.

How can I find out if I’m at risk for hepatitis infection?

CDC offers 5-minute online Hepatitis Risk Assessment Tool. This tool allows people to answer questions privately and get tailored recommendations based on CDC’s guidelines to discuss with their doctor.

Last revised: 05/07/2014