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According to a CDC fact sheet:

• People with HIV infection are disproportionately affected by viral hepatitis.

• About 80% of people with HIV who inject drugs also have hepatitis C virus (HCV).

• HIV co-infection more than triples the risk for liver disease, liver failure, and liver-related death from HCV.

What Is It?
Hepatitis means inflammation of the liver. 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. People can get some forms of viral hepatitis the same way you get HIV—through unprotected sexual contact and injection drug use.

HIV Co-infection
People with HIV infection are often affected by viral hepatitis. About one-third are co-infected with either HBV or HCV. More people living with HIV have HCV than HBV. 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 HCV and HBV—has become the leading cause of non-AIDS-related deaths among people with HIV and they can be at increased risk for serious, life-threatening complications.

Anyone living with HIV should be tested for HBV and HCV. Although some HIV medications also treat hepatitis, co-infection with hepatitis may also complicate the management of HIV infection. To prevent co-infection for those who are not already infected with HBV, the CDC Advisory Committee on Immunization Practices recommends HAV and/or HBV vaccination of people with high-risk factors for HIV.

Hepatitis Transmission
People can be infected with the three most common types of hepatitis in these ways:

• HAV: Ingestion of contaminated fecal matter, even in tiny amounts, from close person-to-person contact with an infected person, sexual contact with an infected person, or contaminated food, drink, or objects, including injection equipment.

• HBV: Contact with infectious blood, semen, or other body fluids; sexual contact with an infected person; sharing of contaminated needles, syringes, or other injection drug equipment and needlesticks. In addition, an infected woman can pass the virus to her newborn.

• HCV: Contact with blood of an infected person, primarily through sharing contaminated needles, syringes, or other injection drug equipment, and, less commonly, sexual contact with an infected person, birth to an infected mother and needlesticks.

• Chronic HCV is often “silent,” and many people can have the infection for decades without having symptoms or feeling sick. Compared with other age groups, people aged 46 to 64 are 4 to 5 times as likely to be infected with HCV.

• Any sexual activity with an infected person increases the risk of contracting hepatitis. In particular, unprotected anal sex increases the risk for both HBV and HIV among MSM, and direct anal-oral contact increases the risk for HAV.

Hepatitis Prevention
People with HIV can lower their risk of contracting hepatitis by not sharing toothbrushes, razors or other personal items that may come into contact with an infected person’s blood. Do not get tattoos or body piercings from an unlicensed facility. Just as HIV-positive individuals would not want to engage in behaviors that would put them at risk for hepatitis, these same behaviors would also put others at risk for HIV.

• HAV: The best way to prevent HAV infection is to get vaccinated. The Centers for Disease Control and Prevention (CDC) recommends vaccination for HAV for people who are at risk for HIV infection, including MSM; users of recreational drugs, whether injected or not and sex partners of infected people.

• HBV: The best way to prevent HBV infection is to get vaccinated. CDC recommends vaccination against HBV for people who have or are at risk for HIV infection, including MSM; people who inject drugs; sex partners of infected people; people with multiple sex partners; anyone with a sexually transmitted infection; and health care and public safety workers exposed to blood on the job.

• HCV: There is no vaccine for HCV. CDC estimates that people born during 1945 through 1965 account for nearly 75% of all HCV infections in the United States. The best way to prevent HCV infection is to never inject drugs or to stop injecting drugs if you currently do so. If you continue injecting drugs, always use new, sterile syringes and never reuse or share syringes, needles, water, or other drug preparation equipment.

Testing and Treatment
Health care providers use blood tests to detect viral hepatitis. The virus can be detected even if a person has no symptoms. In the case of HBV, the test result can help determine if a person has been infected and, if not, whether he or she would benefit from vaccination. If an antibody test is positive for HCV, a follow-up test must be done to confirm current infection.

Treatment for viral hepatitis varies. 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. Both chronic HBV and HCV can be treated with antiviral medications. For HBV, treatment can delay or limit the effects of liver damage. Many people infected with HCV experience clearance of the virus as a result of treatment. Newer approved treatments are shorter, have fewer side effects, and may be more effective.

Co-infection with viral hepatitis may also complicate the treatment and management of HIV infection. Because viral hepatitis infection is often serious in people with HIV infection and may lead to liver damage more quickly, CDC recommends that all people with HIV infection be tested for HBV and HCV. The CDC also recommends that everyone born during 1945-1965 should be tested at least once for HCV.

HIV/HBV and HIV/HCV co-infections can be effectively treated in many people, but treatment can be complex and people with co-infection should look for health care providers with expertise in the management of both HIV infection and viral hepatitis. A 5-minute online Hepatitis Risk Assessment tool at www.cdc.gov/hepatitis/riskassessment allows people to answer questions privately, in either their home or a health care setting and get tailored recommendations based on CDC’s guidelines to discuss with their doctor.

Copyright 2018, Positive Health Publications, Inc.

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