HIV And
hepatitis co-infection

Hepatitis A is typically transmitted through contaminated food or water and usually resolves on its own. Vaccination is available and recommended.

Hepatitis B (HBV) is transmitted through blood, sexual contact, and from mother to child during birth. It can become a chronic infection and, over time, lead to liver damage, cirrhosis, or liver cancer if untreated. A highly effective vaccine exists.

Hepatitis C (HCV) is transmitted primarily through blood-to-blood contact — most commonly through sharing needles or syringes, but also through sexual contact, particularly in men who have sex with men (MSM) with HIV. There is no vaccine for hepatitis C, but it can be cured with a short course of oral antiviral medication in most people.

Shared transmission routes
HIV and hepatitis C are both transmitted through blood-to-blood contact. Hepatitis B is transmitted sexually and through blood, similar to HIV. People who have been exposed to one virus may have been exposed to the same risk factors for the other.

Immune suppression
HIV weakens the immune system by reducing CD4 cells — the white blood cells responsible for fighting infection. A suppressed immune system is less able to control hepatitis viruses, which means co-infected individuals progress to liver complications faster than people with hepatitis alone.
For people with untreated HIV and hepatitis C, liver disease can progress to cirrhosis in as few as 10–15 years — compared to 20–30 years in HIV-negative individuals.

Healthcare access
People living with HIV — particularly those in communities with less access to regular, affirming healthcare — may not have been screened for hepatitis or may not have received hepatitis B vaccination. Co-infection is more common when screening and prevention are not part of routine care.

This is exactly why comprehensive screening matters.

Many people with hepatitis B or C have no symptoms at all for years, or even decades. When symptoms do appear, they can include:
Fatigue
Jaundice (yellowing of the skin or eyes)
Abdominal pain, particularly in the upper right area
Nausea or loss of appetite
Dark urine
Joint pain
But because hepatitis often presents without symptoms, the only reliable way to know your status is to be tested. Liver damage can progress silently long before symptoms appear — which is why screening is so critical.

If you are living with HIV and have never been tested for hepatitis B or C, please ask us about it at your next appointment.

Several antiretroviral medications used to treat HIV are also active against hepatitis B — including tenofovir, which is commonly included in HIV treatment regimens. This means that for many people, HIV treatment simultaneously addresses hepatitis B.

However, not all HIV regimens treat hepatitis B, and stopping some HIV medications can cause a "flare" of hepatitis B activity that can be dangerous. This is why it is critical that your care team knows your hepatitis B status before prescribing your HIV treatment.

Hepatitis C treatment for people with HIV uses the same direct-acting antiviral medications used in HIV-negative patients — and with similarly high cure rates. In most cases, HIV and HCV can be treated simultaneously.

The key is identifying co-infection through testing so treatment can begin.

Get vaccinated against hepatitis B
If you are living with HIV and have not been vaccinated against hepatitis B, vaccination is strongly recommended and is part of standard HIV care guidelines. The vaccine is highly effective and safe. Ask us about it at your next visit.

Get screened
If you have never been tested for hepatitis B or C, ask for a test. Screening is simple — it is a blood test — and it can change the course of your care.

Harm reduction
Hepatitis C is most efficiently transmitted through shared injection equipment. If you use injection drugs, never share needles, syringes, or other equipment. Harm reduction programs, including syringe service programs, reduce the risk of both hepatitis C and HIV transmission and save lives.

Know your status — and your partner's
Hepatitis C can be transmitted sexually, particularly in the context of anal sex with HIV-positive partners. Condoms reduce this risk. Open conversations about testing and status protect everyone involved.