People Coinfected with HIV and Viral Hepatitis
People with HIV/AIDS should be vaccinated against hepatitis A and B and tested for hepatitis B and hepatitis C.
Beginning in 2020, CDC and the Advisory Committee on Immunization Practices (ACIP) began recommending that all people with HIV who are ≥1 year of age be vaccinated against hepatitis A and receive postvaccination serologic testing ≥1 month after completing the hepatitis A vaccine series.
Further, CDC and ACIP recommend that unvaccinated people with HIV receive hepatitis B vaccination. Vaccination should be followed by serologic testing to confirm adequate immune response. CDC recommends that people with HIV be tested for hepatitis B.
CDC now also recommends one-time hepatitis C testing of all adults (18 years and older), including those with HIV. CDC continues to recommend people with risk factors, like people who inject drugs, be tested regularly.
People with HIV and Hepatitis A
People with HIV who have underlying liver disease are at risk for severe disease from hepatitis A infection, and widespread hepatitis A outbreaks associated with person-to-person transmission have been occurring in the United States since 2016. Therefore, CDC and ACIP recommend hepatitis A vaccination for this population. Because the response to the vaccine might be reduced in people with HIV infection who are immunosuppressed, postvaccination serologic testing should be performed for all people with HIV infection ≥1 month after completing the hepatitis A vaccine series. All people with HIV infection who receive hepatitis A vaccine, regardless of postvaccination serologic testing results, should be counseled that the vaccine might not provide long-term protection against hepatitis A. Therefore, they might need to receive immune globulin (IG) after a high-risk exposure (e.g., a sexual or household contact).
People with HIV and Hepatitis B
Hepatitis B virus (HBV) and HIV are bloodborne viruses transmitted primarily through sexual contact and injection-drug use. Because of these shared modes of transmission, a high proportion of adults at risk for HIV infection are also at risk for HBV infection. People with HIV who become infected with HBV are at increased risk for liver-related morbidity and mortality [1-4]. To prevent HBV infection in people with HIV, ACIP recommends universal hepatitis B vaccination for all susceptible people infected with HIV . The first vaccine dose can be administered immediately after collection of blood for prevaccination serologic testing  and regardless of CD4+ lymphocyte cell count . To confirm adequate immune response, post-vaccination serologic testing for protective concentrations of antibodies to hepatitis B surface antigen should be conducted 1–2 months after completion of the hepatitis B vaccine series . People with HIV who test positive for HBV should receive HIV antiviral medication with activity against HBV (e.g., tenofovir and entecavir).
People with HIV and Hepatitis C
In 2009, approximately 21% of adults with HIV who were tested for past or present hepatitis C virus (HCV) infection tested positive, although coinfection prevalence varies substantially according to risk group (e.g., men who have sex with men [MSM], high-risk heterosexuals, and people who inject drugs) [7-9]. As HCV is a bloodborne virus transmitted through direct contact with the blood of an infected person, coinfection with HIV and HCV is common (62%–80%) among injection-drug users who have HIV [8-10]. Although transmission via injection-drug use remains the most common mode of HCV acquisition in the United States , sexual transmission is an important mode of acquisition among MSM with HIV who also have risk factors, including those who participate in unprotected anal intercourse, use sex toys, and use non-injection drugs . HCV is one of the primary causes of chronic liver disease in the United States, and HCV-related liver injury progresses more rapidly among people coinfected with HIV [11-15]. HCV infection may also affect the management of HIV infection [6, 15, 16]. CDC now recommends one-time hepatitis C testing of all adults (≥18 years of age), including those with HIV. CDC continues to recommend people with risk factors, like people who inject drugs, be tested regularly. The American Association for the Study of Liver Disease (AASLD) and the Infectious Diseases Society of America (IDSA) also recommend that people who are coinfected with HIV and HCV be provided with curative, direct-acting antiviral medicationsexternal icon to treat their HCV infection.
Scientific Guidelines and Recommendations
CDC Recommendations for Hepatitis C Screening Among Adults — United States, 2020
MMWR 2020; 69(2);1–17
Sexually Transmitted Diseases Treatment Guidelines 2015
- Gatanaga H, Yasuoka A, Kikuchi Y, et al. Influence of prior HIV-1 infection on the development of chronic hepatitis B infection. Eur J Clin Microbiol Infect Dis. 2000 Mar;19(3):237-9.
- Thio CL, Seaberg EC, Skolasky R, et al. Multicenter AIDS Cohort Study. HIV-1, hepatitis B virus, and risk of liver-related mortality in the Multicenter Cohort Study (MACS). Lancet. 2002 Dec;360(9349):1921-6.
- Bonacini M, Louie S, Bzowej N, et al. Survival in patients with HIV infection and viral hepatitis B or C: a cohort study. AIDS. 2004 Oct 21;18(15):2039-45.
- Weber R, Sabin CA, Friis-Møller N, et al. Liver-related deaths in persons infected with the human immunodeficiency virus: the D:A:D study. Arch Intern Med. 2006 Aug 14-28;166(15):1632-41.
- Schillie S, Vellozzi C, Reingold A, et al. Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. MMWR 2018;67(1):1-31.
- Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. Available at
- Garg S, Brooks J, Luo Q, Skarbinski J. Prevalence of and Factors Associated with Hepatitis C Virus (HCV) Testing and Infection Among HIV-infected Adults Receiving Medical Care in the United States. Infectious Disease Society of America (IDSA). Philadelphia, PA, 2014.
- Yehia BR, Herati RS, Fleishman JA, Gallant JE, Agwu AL, Berry SA, et al. Hepatitis C virus testing in adults living with HIV: a need for improved screening efforts. PLoS ONE 2014;9(7):e102766. https://doi.org/10.1371/journal.pone.0102766external icon.
- Spradling PR, Richardson JT, Buchacz K. Trends in hepatitis C virus infection among patients in the HIV Outpatient Study, 1996–2007. J Acquir Immune Defic Syndr 2010;53:388–396.
- Centers for Disease Control and Prevention. Viral Hepatitis Surveillance—United States, 2015pdf icon. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2017.
- Telfer P, Sabin C, Devereux H, et al. The progression of HCV-associated liver disease in a cohort of haemophilic patients. Br J Haematol. 1994;87(3):555–561.
- Soto B, Sanchez-Quijano A, Rodrigo L, et al. Human immunodeficiency virus infection modifies the natural history of chronic parenterally acquired hepatitis C with an unusually rapid progression to cirrhosis. J Hepatol. 1997;26(1):1–5.
- Benhamou Y, Bochet M, Di Martino V, et al. Liver fibrosis progression in human immunodeficiency virus and hepatitis C virus coinfected patients. The Multivirc Group. Hepatology. 1999;30(4):1054–1058.
- Graham CS, Baden LR, Yu E, et al. Influence of human immunodeficiency virus infection on the course of hepatitis C virus infection: a meta-analysis. Clin Infect Dis. 2001;33(4):562–569.
- AIDSinfo. Fact sheet. HIV and hepatitis C. Accessed July 6, 2018.
- American Association for the Study of Liver Disease/Infectious Diseases Society of America. HCV Guidance: Recommendations for Testing, Managing, and Treating Hepatitis C. Available at https://www.hcvguidelines.org/external icon. Accessed July 6, 2018.