Co-infection with Hepatitis

Having HIV and hepatitis B or C, is commonly referred to as co-infection. Co-infection with hepatitis B or C is not uncommon. Estimates are that:

  • Around 6% of Australians with HIV also have hepatitis B.
  • Around 13% of Australians with HIV also have hepatitis C.


Hepatitis Transmission

Hepatitis B (hep B) is transmitted via blood or other bodily fluids such as saliva, vaginal secretions, semen and breast milk, which is very similar to the transmission routes for HIV. Hepatitis B can be transmitted by the sharing of any injecting equipment (not just needles), by sexual contact that may tear or break the lining of the anus or vagina, and from mother to child during breastfeeding.

Hepatitis C (hep C) is transmitted via blood to blood contact. For example it can be transmitted by the sharing of any injecting equipment (not just needles). Hepatitis C is not normally considered to be sexually transmissible. Having HIV can lead to increased levels of hep C virus in the blood, so having HIV and hep C may increase the risk of hep C virus being transmitted to others. There is also some evidence that suggests that having HIV increases the risk of contracting hep C and may make it possible to contract hep C via sexual contact.


Avoiding hepatitis

  • If you are sexually active, practise safe sex. Correct use of latex condoms can help prevent transmission of hep B, but even when used correctly, condoms may not be 100% effective at preventing transmission of hep B.
  • If you inject drugs, do not share needles or any other injecting equipment.
  • Do not share anything that might have blood on it, such as a razor or a toothbrush.
  • Think about the health risks if you are planning to get a tattoo or body piercing. Ideally get it done professionally. Do not opt for home piercing or tattooing.
  • In general health care, health care workers should follow standard precautions and handle needles and sharps safely.

What effect does hepatitis B have on HIV?

There is no evidence that hep B speeds the progression of HIV or that hep B has any effect on the way HIV responds to antiretroviral therapy (ART). However, when a co-infected person starts ART, there may be a higher risk of the antiretroviral drugs causing damage to the liver. This is known as hepatotoxicity. A series of blood tests called liver function tests (LFTs) can be used at this time to carefully monitor how the liver is coping.

What effect does HIV have on hepatitis B?

People with hep B who also have HIV are less likely to fight off the hep B infection than those who do not have HIV. As a result, they are more likely to develop chronic hep B and are at increased risk of cirrhosis, liver cancer or liver failure.

How does having hepatitis B affect HIV treatment choices?

Some of the HIV antiretroviral drugs also have strong effects against hepatitis B.

People with hep B/HIV co-infection who begin treatment with HIV ART are recommended to use drugs that treat both viruses. The treatment is continued until it stops being effective against one or both viruses. After this, some components of the treatment may be changed depending on which virus has becoming resistant to the treatment.

What effect does hepatitis C have on HIV?

There is still some debate about whether hep C affects HIV. Some studies have suggested that hep C infection can lead to more rapid progression of HIV but others have not.

What effect does HIV have on hepatitis C?

Hep C is a more serious illness for people with HIV, as disease progresses more rapidly in these patients. The reasons for this are not known, but probably relate to a reduced ability of the body to control hep C with HIV infection. You should discuss this issue carefully with your GP or an infectious diseases specialist.

How does hepatitis C affect HIV treatment choices?

HIV can still be treated even if you also have hep C. In fact, it is really important to be aware of your HIV viral load and your CD4 count, and to treat HIV to keep it under control.

Hep C can affect HIV treatment choices, because of the potentially toxic effects some HIV drugs have on the liver. There is no accepted list of 'best HIV treatments' for people with both HIV and hep C. Many different HIV drugs can affect your liver in the short and long term, but both viruses need to be considered when planning treatment with your doctor.

Anything else?

People who have hepatitis co-infection can help themselves by avoiding high alcohol consumption and by not being overweight. Ideally, people with hepatitis co-infection should stop drinking alcohol altogether. Your doctor and The Albion Nutrition team can help you make dietary changes if you need assistance in this area.

Your doctor is likely to regularly check up on how your liver is coping, to make sure the HIV drugs are not causing any problems.